73-522 - Laserfiche WebLink

Home Browse Search

M_ FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ..................................:.:................... Permit No. .. (Complete in Triplicate) ~ .:....................................................: -.:. .•.•> This Permit Expires 1 Year From Date Issued • .- Date Issued .j 70 0 Application is hereby made to the San Joaquin local Health District fora permit to construct and instal the work herein described. This application is made in compliance with Counfy Ordinance No. 549 and existing Rules and Regulations, JOB ADDRESSJLOCATIO -.-.. .J'� m ..: �"•�'G�� kE IjU�J4ACT ...... ... Owner's Name ... .. .............. ........... hOY �i!u r Phone ........................ ...... Address .......... .f...0 �d X... ...f �Lt71.1_:!�r:L.Cj.I!,................ City .��!'.��..._.................... ..................... . . Contractor's Name . a............:.::....... ----�. ...... .-----•.....................License ,#�7/..�.•�'.�....... Phone .l��s.1.;�.f..�..... Installation will serve: Residence ❑ Apartment House❑ Commercial ❑Trailer Court 0 Motel ❑Other .. ..1-.t.<t S-- ........ Number of living units:...o-. .�Number of bedrooms :garbage Grinder .....---.-lot Size ... . .. ..:. �l-r ....-.. i Water Supply: Public System and name ...... ..............................•--••---------------•-.............................- ...................Private � - Character of soil to a depth of 3 feet: Sand E] Silt❑W Clay Peat❑ i Sandy Loam 0 Clay Loam [31 Hardpan 0 Adobe' FIII Material .1411 .. If yes,type ..........•................. � C3 (Plot pian, 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_RubliCLsewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK[ Size. k.................. Liquid Depth ...Y................... Capacity .... ........ Type .. "tt,��nn Material... Compartments ...e.. ................. Distance to nearest: Well ......... .w....................Foundation �� ..... P f----._.. Prop. Line ... ................. ; �. ... Total Length . ...... LEACHING LINT: [1}�No. of Lines .....�.................. Length of each line......� ......... g •--••. •• ••••••. Q �� cr 'D' Box ./11........ Type Filter Material ....................Depth Filter Material .. .: ..........._..._...................... _-Distance to nearests Well 1-541"Y ____. Foundation IL Property Line . 1 SEEPAGE PIT [ Depth ... .......... Diameter y,X ....... Number ......... . F .......... Rock Filled Yes lo ❑ j .... Water Table Depth ...........7.f/ .........................Rock Size ... .li-.1:.............. .... Distance to nearest: Well ,4.. & ....Foundation ../..42 Prop. Line ....f REPAIR/ADDITION(Prev. Sanitation'Permit+# ..................•......................... Date ......................: .........) SepticTank (Specify Requirements) ................................................. ......................................................... ...................... DisposalField (Specify Requirements) ...............................:......••----•---._..............................:..........................----_._ ........... ..............................................................................................-.....................................................................................I...... (Draw existing and required addition on reverse side) I hereby certify that I have pFepared 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 Joaquinlosal-flealtliDliffllf. Hoont owner or liter. sed agents signature certifei�the�following: I-- "I certify that in the perfororiance of the'vvor-k.for-w-hic-b'thia' Wbrllm t is i�suod;J shall not,ompioy any.-person In, such manner as to become subject to Workman's Compeatsallon laws of California. Y Signed ...................... ................. .........................•................ Owner By ................... ... .... ..��.`......................... Title ....... '1.��.......................... (If other h n'owned FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY w �- .............. . DATE _.i'?.`a. . .7.ft. ::........... BUILDING PERMIT ISSUED ..................DATE I ADDITIONAL COMMENTS ..................:.........::...................................._--.......................................................................................... ................................................................................................... •----------..................................... .. .... . ...................................................................:...............................................................................................................................I...... Final inspection by, .............' ... .. . ..................................................Date .. . ...d .�L..:a ........: __.-.SAN.JOAQUIN -L 1 HEALTH DISTRICT ff L t 'A 94 , r.. 7/723M