72-55 - Laserfiche WebLink

Home Browse Search

rum office USE: i APPLICATION FOR SANITATION PERMIT 7�Permit No. .---.......I... (Complete in#iplicatelt ................. ................................... .. This Pedhit Expires 1 Year From Date Issued 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 existing Rules and Regulations, JOB ADDRESSAOCATIO .Q...... ..............-.._._.... `L fi..�_. .,.................CENStJ5 TRACT ..... Owner's Name ._•--•-•--•- .......:41. ............. ..................._..----------._..Phone _................................... Address ..................-----------.......ao-L-Lo---•--�.:-------1 mAl-C)........ City ..._ _.� L t? + ...... Contractor's Name .-----0--1_S.Q-n____.---_ !g�. k0_-e...._..---••---•---_-_--.License # de .�7-�1_ ._ Phone --- Installation will serve: Residence Apartment House f] Commercial OTrailer Court O MotelO Other----✓✓-��--- -••--•---- ....................... Number of living units:...6--_- Number of bedrooms .A—-----Garbage Grinder ------------ Lot Size ..._ ........... Water Supply: Public System and name ....... ----•...................._......._..--•-------.._------•----•--....---------•-----.....--------•--...Private Character of soil to o depth of 3 feet: Sand O Silt O Gay O Peat O Sandy loam K Clay Loom ❑ Hardpan O Adobe 0 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: Wo septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT I ] SEPTIC TANK( ] Size.............. •-4-_--------. PrL � -- D ----- .--_ liquid. Depth ----=------- Capacity .�f�D_. ----- Type .f `.05 . Material_Ct)}1t.Y_.__ . No. � Compartments p •. ............. Distance to nearest: Well ....�-�...... ...�___..........Foundation Z Q__:F-_._- Prop. Line .../. LEACHING LINE [ ] No. of Lines .....1...__.--------- Length of each line 41 Total Len th .U. .. l ..........� 'D' Box --- Type Filter Material l.2.__6&Depth Filter Material ._ ...........5-i .....-O Distance to nearest: Well _ b. __._:..[� Foundation -��-. f Property Line .. �. f ..... ............ SEEPAGE PIT, ( ) Depth J-0. Diameter LI X. _. Number .----� Rock Filled Yes , No O Water Table Depth -•--•---------------------- Rock Size -•---•-- .. ....--•--- fo Distance to nearest: Well'.. - ��--- ----------_-Foundation��..�Prop. Line -_.. �--.�. REPAIR ADDITION(Prev. Sanitation Permit# ............................................ Date ----._......_ ................... Septic Tank (Specify Requirements) -•-........... •........................ ............. ............... ._ Disposal Field (Specify Requirements) ---•-- •-----•------------_------...-_----------- --•--- -•-------------------------------- -• ------------------- ------•--- • --- - -----------------••--------._..--------------------------. -------------------------------- (Draw existing and required addition on reverse side) - I hereby certify that 1 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 Son Joaquin Local Health District. Herne owner or licen- sed agents signature certifies the following: "l certify that in t e performance of the work for which this permit is Issued, I shall not employ any person In such manner as to become s�eclorkm 's C mpensatton taws of Caiifornta." Signed TL 1.. Owner d By ..._.. •------- -•----- --- Title ....-l_�.i�a m— --��' (if other than owner) R D RTME19T USE ONLY APPLICATION ACCEPTED BY -------- ._ .�_._ DATE - .----.---__- BUILDING PERMIT ISSUED -------------.............................................----- --•----•-------------- -------DATE - -------------•- ----•------_..... ADDITIONAL COMMENTS -------------------------- --------------------------- --------.. ------------- ------ -------------------------------------- --------------------- ----------•-•--••- _ Final Inspection by; ............ Date . i� EH 13 2h 1-68 Rev. 5M ------- ------ SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M