753 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 0 Permit No. -:�` ..3 ................0._......._........-- ----•- (Complete in Triplicate) ... Date lssued .-"'- .3- this Permit Expires 1 Year.From Date issued, ...... ................. ........... . cal ealth rict for a l4he work herein the n Joaquin Lo Application is hereby made i5 ode in compliance wiHh County tOrdindn a permit and existing Rulestalnd' Regulations.- described, egulat ons.- described. This application - JOB ........ - -.,.....,-.CENSUS TRACT :----•-••...............:. ADDRESS%LOCA ON .:f-.�� ...___ -- � .._.�. _ -;'- ---- �-- -- - ••- owner's Name i--- �� 7 ' ".... ................• Phone Address . --- ----- city -License # .................... Phone ......................--••-- Contractor's Name .. ,�� 7�✓Q -.. . -------•- - installation will serve: Residence�Apartment House❑ Commercial []Trailer Court [] Motel ❑Other - _--------...- F Number of living units:....._.. Number off b�edrooms -__.__Garbage Grirld�er .•. Lot, Size ....................... 5 4.�k� / / /f�J., -_ ---y---•---------± Private ❑ Water Supply: Public System and name . --.- .-- Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ i 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: k INo septic to k or seepage pit permitted if public sewer is available within 200 feet,) { k Material.---- --+._..._.'.:._. liquid Depth .......................... PACKAGE TREATMENT 7 SEPTIC TANK� Sixe..••------------ -------� �} Capacity .. .... .._... Type . Compartments .. I` Foundatioi► ......No-- Prop. Line ............ Distance to nearest: Well . . ..................... Length of each line ........ .....`:.___ .._._, Total Length ---------_-------. LEACHING LINE � tNo. of Lines ... ) 1 .. Len 9 'D' Box ...._. Type Filter Material - ,-..-.,Depth rias - ---------------- ------ I Distance to nearest: Well Foundation th Filt�r Mate . _. _. Property fine ._..__�................. _._.- - i SEEPAGE PIT [ { Depth Diameter ....---•--...... Number _."-------- ---------- Rock Filled Yes ❑ No r •--- ----Rock Size --_-_--. ----- p Water. Table Depth",...-,•-------.._................. - - ------• Distance to nearest: Well ----------------------------------Foundation Prop. Line ---••----------....... REPAIR/ADDITION{Prev. Sanitation Permit# ........................ ....... Date -"--------------------------------) - Septic Tank )Specify Requirements) ._ . -. ......... " vS sd ....y Disposal Field (Specify Requirements) .- - •• S Sy " r �a .. . ................................... ------ ............. - {Dra'w existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work will be done in accordance with Son 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 person in such manner as to become subject to Workman's Compensation laws of California." Signed --_ ...... ...... .... Owner --------------•---.... Title ........ F (I er than ner) I' f DEPART ENT USE ONLY - i APPLICATION ACCEPTED BY ._....-! - .. ... - - - ---. DATE �.3._--- -------- ---•-•--- BUILDING PERMIT ISSUED "_.... ....... _ :...-._ k -• ADDITIONAL COMMENTS _.._�Iivr- - � _ ----------------- ------- -----� ..-- -------. ... _.. . ..---- ---- ,�.�---------- --- ......... ............ ...... -----•---- ----------------- - ------------ ---• .... Final Inspection b . --- -- -----• - ------------ . .....---flare ... ..�... ._..---."._..._....--•---- --- SAN JOAQUI LOCAL..HEALTH DISTRICT G ..: 7/72 3 ,K