73-263 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: AppLIGATiON FOR 5ANITA7JON PERMIT }= -- --- ----- - -------- -------- (Complete in•Triplicate] Permit No. .__. ______ I Date Issued _. __� -73 ------------------_------ ------------ .--------------_ This Permit Expires 1 Year.From Date•Issued r 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 ADDRESS/LOCATION . f- ��1.__ .__ f {� - ---- --- ---- ---------CENSUS TRACT -N-7 Owner's Name Phone ----------•- --- ---------------------------------- I --- Address --- 3j----��--- - '`�'�-. " �.__ --------------------------------------- City�-- ---- ---------- ------------------------ r Contractor's Name _ .____ _.________;_ tele __-License #c ''.�'/� _- Phone Installation will serve: Residence,�(Apartment House,❑ Commercial :❑Trailer Court !❑ Motel ❑Other --- ------------------------------ Number of living units:---- Number of bedrooms --. ------ Grinder - ___ Lot Size _________ __ —_...__. Wafter Supply: Public System and name ----- -- `-- -'- -----------4[1- -------------------Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam -❑ Clay Loam ❑ Hardpan ❑ Adobe k 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.) \ E NEW INSTALLATION: [No septic tank or seepage pit permitted if public sewer is available within 200 feet,) i, PACKAGE TREATMENT ( ] SEPTIC TANK' Size__ _ ___ _ ---------------- Liquid Depth _____ --------------- Capacity/..&_!?_ 6 1•Type Z&Ade4,_�tMaterial__(f4-- No. Compartments __A�_______-:--_ Distance to nearest: Well ____vSS` _`________________ __Foundation ....e"' �__,___ Prop. Line 4�_�._._..._..-_ LEACHING LINE No. of Lines ----%7 Length of each line------/t_1-_---_______ Total Length :___ra`�_a_�!.......... __ fF `D' Box --- -------- Type-Filter Material � -__Depth Filter Material _._��- --------------------- -------- Distance to nearest: Well _16V -___--_:---- Foundation ____/4__------------ Property Line. -- ____�___........ F d "r SEEPAGE PIT ( Depth _c'+...5~------- Diameter 1_?__-_-________ Number ___-.__ ----------- Rack Filled Yes * No ❑! Water Table Depth ------� ----------------------------------Rock Size ------&P-2--------------------- Distance to nearest: Well __ G fd ------------------- ----•--Foundation �-------------------- Prop. Line -----••----•---- REPAIR/ADDITION(Prev. Sanitation Permit# -------- ----------------------------------- Date ---------------------------------- Septic ---_____________________________Septic Tank (Specify Requirements) -------------------------------------------------------------------------------------------- ---------------------------------------------- e Disposal Field {Specify Requirements) ---------- - ---------------------------------------------------------------------------- --------------- -- ------------------------------------------------------------- (Draw existing and required addition on reverse side) I 1 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- 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." Signed ------------------------- ------�- Owner BY ----------- Title (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY " ----------------------------------------------- DATE --- ---- _ --- -- --------- BUILDING PERMIT ISSUED ------------------------------------------------------- -------------------------------------------DATE ------------- ----------------------------- ADDITIONALCOMMENTS -- - -------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------- -------- - ----- ---------- ------------------- --------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------- - Final Inspection by: 1._� Date SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M