73-1058 - Laserfiche WebLink

Home Browse Search

FOR OFFICE.USE: APPLICATION FOR SANITATION PERMIT ,4 - Permit No: ."�3=1a _. f ---- --- ------------------------- --->---------- - � �. (Complete in Triplicate) , _ - Date Issued _l.�---.__".7-3. 1' ------------------------------ This Permit Expires 1 Year From Date Issued ` w 4� ;" . r Application is hereby made to the�an Joaquin Local Health District for a permit to construct and install the work herein k described. This application is made in compliance with County Ordinance No. 549 arid existing Rules and Regulations: s CENSUS TRACT ------ --_---`'� JOi3 ADDRESS/LOCATI N -_� � -------- Phone ----------------- Owner s Name '} -_------ t�- ------ - - - rte- �..: Address -��j�,- -��+1�Q�---��` ---------------------------- City -- - -------------- -------- ------------------------------------------ - --- - ze? Contractor's Name ----- _�.1,_ (1�_ [\------------------------------------=-------.License # 06s Phone Installation will serve: Residence •Apartment House, Commercial ❑Trailer Court l❑ I Motel ❑Other -------------------------------------------- Number-of living units:------------ Number of bedrooms ___________-Garbage_ Grinder __-_---_.-_; Lot Size __- - --------------------- Water Supply: Public System and name ------------------------------ j -----_-------------Private ® j Character of soil to a depth of 3 feet: Sand'❑ .,-Silt:E3 ...!Clay_❑_:.Peat❑^5c�ndy logm_(g1 Clay Loam❑__ . t Hardpan ❑ Adobe.M Fill Material ------------ if yes, type ____-----_.-_-_______---___ t r (Plot plan;,'-showing size of lot, location of system -n relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION:�;3 dl�o septictank or seep a pit permitted if public sewer is �alilable within 200 feet,) !� PACKAGE'TR>f/�`7lU1ENT;� [� - SEPTiC TANK [ Size--- ?_X_ ' ---------------- ------ Liquid .Depth ----i ----•--,-•--- k �ateriai______________________ No. Com artments [ � Capacity JQl!_'U- Type -�--P------------ P ------ -------- Foundation -------------- Pro Line __'-��.-_v .stance to nearest: Well -_ -------- ----- 1 P• / J LEACHING LINE [ 01 No..„of Lines .-�_-------------- - 9 _ __ +line------7�-------- -- Total Length ---_ --'r�----._._._:-: .� D' Box ._t�_�.- Type Filter Material 20 7C�/-�-Depth Filter .Material --- f----------------------------------- n �"--- .-------------------- J ` 1 } ° Distance to nearest: Well ___ �--,-----__ -- Fou ndation �r------------ Property Line .-t _________._•--_-- N . SEEPAGE PlT [ ] � Depth - Diameter _ - Number ------------------ ---- Rock Filled Yes ❑ No , P 1 Water Table. Depth _-- -_- -Rock Size -------------------------------- ---------------- i Distance to nearest: Well _____________ __-- ----------__-••-Foundation -------------------- Prop. Line ..___-____---•--____-- # REPAIR/ADDITION(Prev. Sanitation Permit# -------- ----------- ------ Date -------------------•--------------) I°''-�'- --° _=__ -= -•: ----------------- - Septic Tank {Specify Requirements) -�---.- _ ------------� ? Disposal Field (Specify Requirements) �- ------------------ -------------- --------------------------------------------- ----' (Draw existing and required addition on reverse side) 4 + li --�I�-hereby--certify-that !1I 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 )sten- sed agents•signature certifies,the following: "1 certify that in the performance of the work for which this permit.is issued, 1 shall.not employ any person in such manner as to become subject to orkman's Compensation laws of California.” i f a --------- Owner i r Signed � ��.'-- �---� ------------------------------------------- BY 1 itle (If other than owner)° i FOR .DEPARTMENT_USE ONLY _- _e. ------------------- - DATE =T=` ------ APPLICATION ACCEPTED BY ------_ __ - BUILDING..PERMIT ISSUED------------------------------------------ DAT.E_�__ ------------------------- ADDITIONAL - - ADDITIONAL COMMENTS ___________ ___ j et�-V ................. ...... ------ --------- _ ..�. t—� - Date Finallnspects _ - ----------------------- 4 -------_- _ SAN JOAQUIN LOCAL HEALTH DISTRICT E. H.r9, 1-'68-Rev.M _40