75-623 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USEt '�.� APPLICATION �_. FOR SANITATION PERMIT .: .- (Complete in Triplicate) Permit No. :3 Date Issued y-73 • This Permit Expires 1 Year Front Date issued . Application is hereby made to the San Joaquin Local Health District for a permit to construct and Install the work herein described. This application is made in compliance with County Ordinance No. 549 and eicisting Rules and Regulations- JOB ADDRESS/LOC _ �� ._ ,t►/t................... ,• --• .... h SUS TRACT ...........................Owners Name �. .. ..... .._ PhonelAddress 1747-9- .......... CitA�`ha ...... _ "Contractor's Name / --... cense Phone' . S" Installation will serve: Residencefg Apartment House}] Commercial OTraller CoetrP .0 Motel ❑Other ................................ Number of living units: Number of bedrooms ............Garbage Grinder .......... Lot Size r� �-----..--------:. Water Supply: Public System and name ................................. .........:......—...---•••......-----• ------------------------ -•.,-- Private ❑- Character of soil to a depth of 3 feet: Sando SIIt C] Clay 0 Peat❑ Sandy Loatn 0 may Loam ❑ Hardpan 0 Adobe 0 Fill Material ...__... ... If yes,type (Plot plan, showing size of lot, location of system In relation to wells, buildings, etc. must be plated on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer Is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANKI Size_. .:.. Liquid Depth Capacity Material._ Nc. Compartments Distance. to nearest: Well r • oundatlon " .... ................. ---- .... ......---... Prop. Line W LEACHING LINE ( ] No. of Lines ....---- Lerigt of each i e.._`................... Total Length i, 9 ............................ O D' Box Type Filter Mat ial p .Depth .Filter Material ............... Distance to nearest: Well ------- ----------- F ndation Property Line ........................ SEEPAGE PIT [ ] Depth - Diamet r .Urn57 Rock Filled Yes ❑ No !❑Q Water Table Depth .Rock Size ...................... 1 ' ------ ... Distance to nearest: Well ........Foundation ........ Prop. Line 3 r _.. REPAIR/ADDITIONlPrev. Sanitation Permit# _ ....... Date ._.:.. ..........4........... } Septic Tank (Specify Requirements) -/ ........................A._..._.........._. Dispose! Field (Specify Requirements) .'-CS. _ - -� . ...... ... (Draw existing and required addition on reverse side) I hereby certify that 1 have prepared this application and that the work will be dons In accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the 'San Joaquin Local Health;Dlstdct.Nome owner or licen- sed agents signature certifies the following.- "I ollowing:"I certify that in the performance of the work for which this permit is Issued, I *half not employ any person in such manner as to become subject to Workman's mpensation laws of California." Signed --.. ?ic ------------ Owner f . ......................... By ............. -- -- -----••-- Jitle ....---•--. .ther than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----- _. � _ .............. DATE BUILDING PERMIT ISSUED .-- ........ ----•-•-----------------•----..._..-•••--•-••----------------------- --...©ATE ITI©NAI COMMENT* -------------- t ------- --•............... ........ ------•--------- --------•--••--------------------- ----- C� I. final inspection by: • ----•- Tim----•�•. •---.... !! --•- --••-•------------------------•--...---=•-•---._......_...._...._....----....__..Date .-..�_.------�'---• •�--------....---- E EH �3 2L 1-68 Rev. 5m SAN JOAQUIN LOCAL HEALTH DISTRICT � a/74 3M I