73-527 - Laserfiche WebLink

Home Browse Search

0 FOR OFFICE USE: I t' I APPLICATION YOR SANITATION PERMIT permit No: -73�s`_--7. - --------------- -=-------------- a .. (Complete in Triplicate) ---------------- ----------------------------------- --- z bate Issued -_ --------.__. --- This Permit'Expires 1 Year From 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 ap lication is ma a com fiance with County Ordinance No. 549 a xistin Rules and Regulations: 9 Z✓ GC/. CENSUS TRACT _. -- ------------ JOB ADDRESS/LOCATION �. 'r Q = Owner's Name r --``�'a "� f�"`.G `'' - Address --.- '.°------------ ---------•------------------------------------ --------•--• City ------ ------------------------- ------------------------------------------- Contractor's Name -------.License # ----- - -------------- Phone ------- -------------- Installation will serve: i` Residence ❑ Apartment House❑ Commercial ❑Trailer Court !❑ i � � � I i Motel Other --� -- --)n" ¢ `�""" Number of living units:_--. -.--- Number of bedrooms ---_-----_..Ga age Grinder ____.--_ Lot Size - -----------------------_------_-_..-__- ' ;P - - Water Supply: Public System and name ------------------------------------ -------=-----------------------------------------------------------------Private Character of soil to a depth"of 3 feet: SandSilt F]- ' Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam;❑ - I� Hardpan ❑ Adobe ❑'rFifl,Nlaterial ------------ 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: (No septic tank or seepage pit permitted`if public sewer is available within 200 feet,) / C PACKAGE TREATMENT SEPTIC TANK ) Sizer �X�_X Y- _._------_--- Liquid Depth ---7--- -------------- [ 7; Capacity ca-.4�0D------- Type _.� f _ Material- - No. Compartments Distance to nearest: Well _��----_----_-_-- ----Foundation _J----------------- Prop, Line _--�.01 _-...--.-- ` - L_. ._.... ._ _-- -- [ ] No. of Lines ------------------------ Length of each line---------------------- ----- Total Length ------------------------ -2 7aXdZ 'D' Box ----- Type Filter Material --------------------Depth Filter Material -9- ..--.------_-..-._-_-_......- Distance to nearest: Well ------------------------ Foundation ------------------------ Property Line ---_---._-__--_ ....... E SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number ----------------------------- Rock Filled Yes ❑ No i❑ WaterTable Depth ----------------------- ------------------------Rock Size ------------- -------------•---- Distance to nearest: Well ----------------------------------------Foundation ------ Prop. Line -.-------------------- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date --__-_--_--_._._--_-_---_....----1 SepticTank (Specify Requirements) ---------------------------------------------------------------------------------- --------- ----- -------------------------------•---------- I Disposal Field (Specify Requirements) --------------------------------------------------------------------------------------------------------------------- ------ ---------------------------------- - ------------------------ - ------------------------------ ------------------------------------------------=---------------------------------------------------------------------------------------------- (Draw 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 San Joaquin County Ordinances, State Laws, and Rules and Regulations of the. San Joaquin Local Health District. Home owner or licen. i sed agents signature certifies the following: "I certify that i the performance of the work for which this permit is issued, 1 shall not employ any person in such manner s to beco e. .ect to Wo man' Compensation la s of California." i Signe --- --------------- --------- Owner BY 1 u Title -------------------------- (If other than owner) ! FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED f3Y ---------------i-------------------- DATE -----70-------- BUILDINGPERMIT ISSUED ------------------------- - ----------------------------------------------'_------=--------------DATE --------------------------------------------- ADDITIONAL -----------------------------------------•-ADDITIONAL COMMENTS •--------------------------------------------------------------------------------------------------------------------------------- --------------------------- ------------------------------------------ -------- ------------------ ------------------------- - .. _ --- Final Inspection by - -- --- --- --- --------------- Date `. SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M;