74-119 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ' APPLICATION FOR`SANITATION PERMIT --------------- ------ (Complete in Triplicate) Permit No. -- ----------------------------------------------- S Date Issued - 71V -----------_---------------__________-__-_______ I This Permit Expires 11 Year From Date Issued 1 Application is hereby made to the7San 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 Mules and Regulations: / a �/\M------ -------------------------CENSUS TRACT -------------------------- JOB ADDRESS/LOCATION - Owner's Name .--4 '- ZGS,12 A 4J,_e---•---- ------------•---------------= � Phone ------------------------------------ Address ------- dG---4- -- - i -- -- - City _ ----------------------------------•-------- Contractor's Nam ___- . _ " License #� ,1.__- Phone�_ac Installation will serve: Reside ce ®impartment House-E] Commercial❑Trailer Court ❑ Motel ❑Other -------------------------------------------- Number of living units:_._]_------ Number of bedrooms 3......Garbage Grinder ------------ Lot Size _ILD---4 —___-_.__... - f Water Supply: Public System and name ---------------------------•-- --•---------------------------------------- -----------------------------------Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam j Hardpan ❑ Adobe ❑ Fill Material ----- -_---- If yes, type ____________________________ (Plot plan, showing size of lot, location of system in relation #o 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,) PACKAGE TREATMENT [ ] SEPTIC TANK[ ] Size-_-/'r _ _55----------------------- Liquid Depth s.J ----_________-_- r Capacity � ddTyp ,_a_4,4-____ Material, No. Compartments _2__------------- 'O►1 Distance to nearest: Well ----------------------Foundation __2Pc7_--_-______ Prop. Line __mss _`-__-_--___ G LEACHING LINE [ ] No. of Lines __ __t2 Length of each line___ -------------- Total Length __l 'D' Box __/------- Type Filter Material -----Depth Filter Material14e----------------------------------- Distance tc nearest: Well -62-43P----------- Foundation ----- -------- Property Line _1�__y_____________ - 10 r SEEPAGE PIT [ ] Depth �_ ---------- Diameter <.� .`.... Number �_--------------- Rock Filled Yes 9' No i❑17— -ice s Water Table Depth --_------�'v --------- --Rock Size - -------------- --- -��_---� - -- - '�� Distance to nearest: Wel! ___ _�____________________Foundation _�C�L?_�___-_ Prop. Line _ s `.....__.. REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date --------------.-.----------------_) Septic Tank (Specify Requirements) ----------------------- -----------•-----,---------- ------------- Disposal Field (Specify Requirements] -----------------j --------------------------------------##---------------------------------------------------------------------------- .t € 1 { --- _-__------------------------------------------'----r-------------------------------------------------•------------------`--------------------------------------------------=-----------•---'-------- ----------------- ---------------------------------k-------------------- -------i--------- I---------------------------------------------------- --------------------- (Draw existing and required addition on reverse side) I hereby certify that I ha ep epared_this application and that the work will be done in accordance with San Joaquin County Ordinances, State Laws,,cnd{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." I c Signed -------- - ---- -- ---' ----- - ------- --- ------------- _= ----------- Owner A __ By ------------------------- Title - - (If of er than ner) ! + t FC_. MEN USE ONLY APPLICATION ACCEPTED BY Y:.- --- ----�----`----------- ----t - -----------. DATE —6 - ---------------- ----- BUILDING PERMIT ISSUED ---------- DATE - - ADDITIONAL COMMENTS ---------------------------- ---------------------- I -- - ----------------------------•------------ �, s I 1 _--- ------------------------------------------ I - ---------- -------- s-...tFinal Ins.ectibn b s. === = _ p ---=;� ---- - =.. ---------------------Da#e �� ------------- --------- ---------- N JOAQUIN LOCAC HEALTH DISTRICT' E. H. 9 1-'68 Rev. 5M +