73-1043 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE., APPLICATION FOR SANITATION PERMIT ........ - Permit No. ............... (Complete in Triplicate) :......-•-•--•---•--•-•--•- , Date Issued .1L` .`.�3 This Permit Expires 1 Year From Date Issued Application is'hereby made fo the Saei Joaquin Local?Healih-District for a' permit t&construct and install the work herein described. This �application is ilnadein compliance with County Ordinance No. 549 and existing Rules and Regulations. JOB ADDRESS/LOCATION ,.. .. . CENSUS TRAGI = ...:. . :.rCr:, ................. A .� __. . Owner's Name .__.. ..�.. _. ............. ;...._....._......,......._.__....:.... Phone....._........_....._.. Address •� � ...... .. f ._. ��:...................................................•---.��'.._............. City �f�-•--..._......-------...---...........�.... s 1 # ��. . � � i Contractor's, -----��-�fL�.f.'._.-•--------------•-•-•.._.............License ••. Phone Installation ill serve: Residence Apartment House 0 Commercial ❑Trailer Court Motel ❑Other .. -•--•---•••..................... Number of ;living units:._. _._.. Number of bedrooms ___9�....Garbage Grinder Lot Size ._416eee�....................... Water Supply: Public System and name ------............................_....--------.............-•---------------....._----•.._..---.......---_.._.Private Character of soil to a depth of 3 feet: Sand'[] Silt❑ Clay ❑ Peat❑ Sandy Loam [] Clay Loam ❑ �%� Hardpan ❑ Adobe 00' Fill Material ............ If yes, type ------_-------------- I F' {plot plan, showing size of lot, location of. system in relation to wells, buildings, etc. must be placed on reverse sidell { � I NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK [ ] Size................................................ Liquid Depth .......................... Capacity Type .$..... Material...................... No. Compartments ........... t Distance to nearest: Well ..............z..............--____Foundation ...................... Prop. Line .................. LEACHING LINE [ ] No. of Lines ........................ Length of eachline............................. Total Length ............................ D' Box i Ty e.,Filter.Material 1 ---De th Filter_Material ------------_.._ . Distance to nearest: Well ... Foundation Property Line ...................... SEEPAGE PIT [ ] Depth---------------------- Diameter ....._. ...... Number ............................ Rock Filled Yes ❑ No �❑ Water Table Depth ---- ................_ _-..-----•-----•-----...Rock Size ................................. Distance to nearest: Well Foundation Prop. Line ...................... fi ! REPAIR/ADDITION(Priv. Sanitation'Permit# ...._._......................•---........... Date .................................. Septic Tank (Specify Requirements) -----------••-•-•••---------_-------- ........ wf.......... ..._.. i Disposal Field {Specify Requirements) /,o; ...... ---------------------------------.------------•---. ...... ----------..._..............--••-------------• ....... -------------------------------------------------- ------------- -..---------------------- (Draw existing and required addition on reverse side) 1 hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin Y County Ordinances, State Laws, and Rules and Regulations of the San Joaquin^Local Health District. Home owner or Rcen- sed agents signature certifies the following: ` V t "I certify that in the performance of the work for which this p6imit is issued, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed �` Owner _ f� _ By ..-.- 1 -----•--•------•........................•.. xitle .G .. . �. ' ._:.__....................... ... i other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ..... .............................................:..:.............'..........................._.. DATE ..........------......................................... BUILDING PERMIT ISSUED ..........r-------------------------••-..•-•---............:.'.::..........-= ••----------•-•---.._DATE _------- ................................ ADDITIONALCOMMENTS ........... ............................................._•--- ).`---......----..__...........---........----------......----....,.__._...........--•--...... ...........................I..........I—,----------• ---.........-----------_.... .....-----....._..•..__._............. ............................ Final Inspection by: .. .Date ..� .::7 ....................... SAN .JOAQUIN LOCAL HEALT ISTRICT F u 13 24 1-,An P.- r, 7/72 3 X