73-508 - Laserfiche WebLink

Home Browse Search

l FOR OFFICE USE: aPPucarIoN FOR 73 SANITATION, PERMIT ..................."----•- -•--•r- J ; Permit Na. -• ---._....__._..... .._... ................. •.-• (Complete in Triplicate) .. ................. Date Issued �1.�...7:.... ........................... .. This Phis Permit Expires I Year From Date Issued 1 <. Application is hereby made to the San Joaquin Local Health DisMit-for a 'pdrmit�t construct and install the work herein described. This application is made in compliance with County Ordinance^No. 549 and existing Rules and Regulations: Q .�... ...CENSUS TRACT JOB ADDRESS/LOCATION ,..1, ..:,._.. .4-eJ:........... ................ ........_. 9 Cfl O� Owner's Name i2S: TVt>t�.l RQToR ....:.................._..Phone . 67f�8..._E _ r?c>s 'City __..��!!,.p e�...... ............. . ...... ............... Address ..__.._..."_._.. . ..--- ` .� 3 Cab `F Contractor's Name ..-•---..��_�::...'iF�f+�rer5r�__�-.�rvs.........................License # •--...Y�......._.... Phone .� Installation will serve: Residence &Apartment House'❑ Commercial ❑Trailer Court l❑ ' Motel ❑Other .................. Number of living units:..-.1------ Number of bedrooms -._.....Garbage Grinder -__.._____._ Lot Size ...__ . ice=....................... 19 Water Supply: Public System and name ...__. ......... ........................................ Private Character of soil to a depth of 3 feet: Sand b Silt❑ Cloy ❑ ' Peat❑ Sandy Loam .E] Cloy Loam 1 - _ •—.�_ rn x •Y _ _- Hardpan ❑ Adobe Fill Material ._....__.... if yes, type ________________ (Plot plan,, showing size of lot, location of. system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: {No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ SEPTIC TANK[ ] Size...........................•---.....----••••. 1 Liquid Depth ........................... ---------- ...._ ....ial...un......-•--"-_. No. Compartments ......................� Type Material Prop. Line ...................... Capacity ........ .. ... Distance to. nearest: Well dation ....__....�.._. LEACHING LINE [ J No. of Lines }----- Length of each line.__--- ------------......... Total Length ...__.............:I-----.---• 'D' Box Type Filer Materidl ....................Depth Filter Material ........................................ Distance to nearest: Well. ...........:............:_Foundat-ion--a...:.--:_— --_l- Property Line ...........___No...•. KI SEEPAGE PIT [ j Depth --- Diameter ................ Number ...._----_-•--_� .......... Rock Filled Yes (3Water Table Depth ......................Rock Size Distance to nearest: Well ---• ----__._.........-..:.Foundation _.__...--•.--•-_---- Prop. Line ..................... 1 = TI :: --.--.......,------------- ........`----_... Date'_.................-----•-•-----•I REPAIR/ADDITION{Prev. Sanitation Permit# Septic Tank (Specify Requirements) ------------------------- ..........................................--•---..; -.- -.1....`.... --_.._..I..._... . 4er Disposal Field (Specify Requirements) .........'T`�- ....... , ;. -----------•--- ---...... ---.... .............. ------- ---------- -------------------•----------------•- ........._............... ....... �..................._._.._....._.............. .................... w (Draw existing and required addition on reverse,sidel I hereby certify that [ have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: "i certify that in the performance of the work'for which this permit is issued, I shall not employ any pe"n in such manner laws of California." E as to become subject to 7okan's Compensation r Signed .. ..............•-•-----..._...._- Owner 6 P.2� .. .. Title .. '--...... By ........ (if other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ._ r. .. --.......-•.................................................. DATE ••-..._..--- -_ BUILDING PERMIT ISSUED ....................................... DATE ----------- _--_---------------------- ADDITIONAL - --------------ADDITIONAL COMMENTS --••----•------_..............................•---------.......----......_._......_•---.........."-----. ....------•••................. ................_......._............................ •-------.....----------------••"••--•-"••............_......... ..........................--""..... = r_........ ....................... - _ -•------ -•-----.. FinalIn by: ....... .... .......... ----.e..... ...........................Date . ..------..... _ --• SAN JOAQUIN.LOCAL' HEALTH DISTRICT �.. F N 7.3 '2�i 7.�68•Rev_•5M .. . ... � 7/72 3 M