73-489 - Laserfiche WebLink

Home Browse Search

1w1=01; OFFICE USE: APPLICATION FOR SANITATION PERMIT Q;30 (Complete in Triplicate) Permit No. .�3.-7. �. I _._......... y........ .......... k-..._..� . Q.. ...._... a3Date Issued This Permit Expires I 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 application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: CENSUS ._._.._. JOB ADDRESS/LOCAT ... N .... ._�� .. .... .... .... .......... ..................... TRACT'......... ----•-•- Owner's Name ....... :..}`�.:....._. . � . ........ ,..... ... ......Phone T Address _ � r city 14� , � 7'.9.....Z...-_.1- Z/ Contractor's Name ......... -•-- •--- -- ------ --- -- ---- ........................License # ..;.SS-y._..1T,1Phon A6: ./...66..1... Installation will serve: Residence ❑Apartment House❑ Commercial (]Trailer Court 0 r Number of living units:....f.,..___ Nuinberflofl bedrooms ...�Y` ba a Grinder = 1 1 r 9 ❑ ......•..._ 9 g ._.._�..._. Lot Size _...___....K. Water Supply: Public System and name ......._.. -•-•------............................•--.........................................................Private ❑ Character of soil to a depth of 3 feet: Sand[] .'Silt❑ Clay ❑ . ,Peat[j Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe Fill Material ......... If yes,type __................... { (Plot plan, showing size of lot, location ofsystem in relation to welts, buildings, etc: must be placed on reverse side.) G NEW INSTALLATION: (No septic tank or seepage pit permitted .if public sewer is available within 200 feet,J "\] PACKAGE TREATMENT ( J SEPTIC TANK.[ ] Size....................... ....................... Liquid Depth .......................... Capacity ...........:......... Type ------__-_..-._ .... Material.._..__. -----:.------,. N. o. Compartments ....................... Distance to nearest: Well ....................................Foundation ...................... Prop. Line ..._.......... ....... LEACHING LINE [ ] No. of Lines ........................ Length`bf,each_line............................ Total Length __..... ......... 'D' Box ...... Type Filter Material ....................Depth Filter Material ........................................ Distance to`nearest: Well ........................ Foundation ........:............... Property Line ........................ SEEPAGE PIT O Depth .......:...........: Diameter ................ Number ................_.. ........ Rock Filled Yes ❑ No {] Water Table Depth ..........{..Rock Size Distance to nearest: Well " - `......Foundation .. Prop. Line REPAIR/ADDITION(Prev. Sanitation Permit.# ............................................ Date .................................. Septic Tank (Specify Requirementsl .................... ,...__......-•••--... ................. ....................-................. --------------------------- - --------------------------- - - - ! .��. _ } ......................... --•...........................•---•---••---•------._- ..._.......... .... . . ....... .... ... 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 Mules 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 .......... . ...-r-•• ;title .................. .................. (If other owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ..... .... ... ••• ..........-- BUILDING PERMIT ISSUED .DATE ADDITIONAL COMMENTS ..•. .. ........ .. ............. .... ...... •.... ... .... .......I............... Final Inspection by: ----...... Date . I . .'" t� j.......... . ;-...., SAN JOAQUIN LOCAL' HEALTH- DISTRICT E. H.13 24 11-'68 Rev- 5M 7177 3 M Y