73-495 (2) - Laserfiche WebLink

Home Browse Search

i. FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Compler'a in Triplicate) ,Permit No. .. .............. .............. Date issued ��:. This Permit Expires ] Year From Date Issued Application is hereby made to the San Joaquin Local Health District for permit' to construct and install the work herein described, This application is mode in compliance with County Ordinance No, 549 and existing. Rules and Regulations: JOB ADDRESS/LOCATI ........ .�_.. IV7` U►.530,19..................... GENIUS TRACT ................... Owner's Name .._..__.AD.•3'.6 '� 4` Gly Phone .�? /:3.�R� .....• :........:.......... .. Address ............. I� ......................................................... City Contractor's Name A ` ...._._..-• ,. Phone..9. 6.2b.:o ... Installation will serve: Residence 01 Apartment House Commercial ❑Trailer Court ❑ i 4 Motel ❑Other ............... ....................... _ ! Number of living units ..... Number of bedrooms ---a.....Garbage Grinder ...--------- Lot.Size Water Supply: Public System and name ._ 4-- ._--_ - .............................................. . ...............Private ❑ I Character of soil to a depth of`3 feet: Sand❑ Silt❑ Clay [] Peat[] Sandy Loam ❑ Clay Loam ❑ JI Hardpan ❑ Adobe 0, Fill Material ...._._ .... If yes,type ----=----------------- (Plot pian, showing size of 'at' t, location .of system in relation to wells, buildings, etc. must be placed on reverse side.) W NEW INSTALLATION: ; (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) W PACKAGE TREATMENT f ] SEPTIC TANK -- ._ T 3 Size....................-.........---................ liquid Depth ......._..._:.---.....---- CapautyTYPe ------ Material...................... No. Compartments Distance to nearest.- Well ...... .............Foundation ... Prop. line LEACHING-LINE ( � No. of Lines ........................ Length of each line--------........- Total Length 'D' Box ------------ Type Filter Material .•..................Depth, Filter Material Distance,to-nearest. Well ....:........ Foundation ........ Property Line SEEPAGE PIT ( j DeptiM _' Diameter ............ N ..... Rock Filled Yes No .` Water,Table Depth -------------------------- ........ I .hock Size_ ❑ 4. Distance to nearest: Well .....::.......: Foundation' •--•...................•- �---------�-....... Prop. Line .........••-•.......... i REPAIR/ADDITION(Prov. Sanitation Permit r# .................... Date ................ Septic Tank (Specify Requirements) - / I ! Disposal Field (Specify Req(1irements} ........ _....' :14-,_.. 333 9C L� t iL2 ^ .. ....................................... a...._... ... •-------------- -------•----- ------------------------ •--------- .......... -....... -------------- ••---- -- (Draw existing and required addition on reverse side) } I hereby certify that I have prepared this application and that the work(w be done en accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local/Health District. Hoene owner or licen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued,� shall not employ any person In such manner as to become subject to War an's Compensation laws of California." Signed .......... . I�I ------n................ . Owner . . t - , By ........ ......... .. - Title _. I/ . . 4 (If other than owners :..:_....... 1 Ih FOR DEPARTMENT lI5 ONLY APPLICATION ACCEPTED BY .iI_. ..••- f- I .....................•--•-._......... DATE . ._- ... = ...... BUILDING PERMIT ISSUED .. ��--------•---. .................. . -••-•--' -•-•-•----.....-•---•.... .-............ _.... ........... ................ ADDITIONAL COMMENTS ......!M.................... -� ......................................... .�. ..- :. ............................I........._.....--- ...:..._ ...-- ........--•-•--•--.................... �I = .. . Final Inspection by: __.... _.... Date iIt SAN JOA IN LOCAL HEALTH DISTRICT , E. H.X3 24 1-'68 Rev. 5M �! -- 7/7*'3 M 1 J