73-871 - Laserfiche WebLink

Home Browse Search

J FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No -3-"-- ------- ------------------------------------------ ------ ---------- ----- (Complete in Triplicate) ------- Date Issued This Permit Expires 1 Year From Date Issued - ----- ----------------------------- i 1 Application is hereby made to the San compliance c withal County alth District an a Nom549 and ex sti g Rulestalnd hRegulations- s k described. This�p„plilc�atn is made �� 1 JOB ADDRESS/ N ---------------- ----------------- 'r Y"'_`_�_ -CENSUS TRACT ` " - -- ------- ------ ------ ------ -, � one -------- ------ i Owner's Name ---- ----------- City ---------I------------- ------------------------------ Address --- -- ------ -------- � - -- ------ -----� _ _= License # - _��- Z-Phone Contractor's Name - _- [i Apartment, Commercial :❑Trailer Court 0installation will serve: Residence Motel ❑ Other _ - - - --------------------- ---- Number of living units:____r_-_ Number of bedrooms _ ______._ Garbage Grinder _-_-__.___- Lot Size I Private [ � Water Supply: Public System and name ----------------------- -- Clay Loam Character of soil to-a depth of 3 feet: Sand'❑ /Silt E] Clay ❑ Peat❑ Sandy Loam ❑ Y ❑ _ I o Hardpan Adobe E] Fill Material -- ----- - if yes,type -- -------- -- -- - - - - - s, etc. must be placed on reverse side.) {plot plan,lan, showing size of lot, location of system in''-�relation to wells, building NEW INSTALLATION: (No septic tank or see ge pit permitted i# public sewer is available within 200 feet, � f / / PACKAGE TREATMENT [ ] � Q SEPTIC TANK'[ Sizer' lX------------- Liquid Depth _q-------------------- SEPTIC °�(7c�2t f __- Material---- �°''" — No. Compartments -------- °�C T e Capacity ______ ___ YP r C'--------------------Foundation ld -- Prop. Line :- k Di"stance�to nearest: Well __-_-_-��----- � ^ 'L�-------- y f� - ---- Total Length :-_-_-�---------- LEACHING LINE ] Bax Ines Length of each line--------- - ----- No. o D' 1 _.__ Type Filter Material __--_,�_f --Depth Filter Material ----- 1 y Property Line. ------------ =-------- Distance.to nearest: Well --�- --- Foundation �' --_---___-_ Rock Filled Yes �No ❑ rn [ i Diameter ��----- Number -------- SEEPAGE PIT Depth '= 11,E •.�• . i '' � -----Rock Size - -- - r----- �------ � i ] Water Table Depth ----------------- Distance. -__---_--- --- ---- I . Distance,to nearest: Well --------�-�a---------------------Foundation ----�--Q____-•---- Prop. Line --------------•------ 9 1 -----------} ` Date --------------- REPAIIt/ADDITION(Prev. Sanitation Permit Y# -------- ---------------- --- ----------------------------------- - --- -------------- ----------- Septic Tank (Specify Requirements) ___________________ __ Disposal Field (Specify Requirements) ---------------------------• ----------------------------- -- ---------------------------- ------------- ------- ------ ----------------------------------------------- ---------------------------------------- (Draw -------- ------- a Draw existing and required h e - --- 1 ( addition on reverse side) r I hereby certify that I have prepared this application and a work will be done in accordance with San Joaquin , and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- County Ordinances, State Lawssed 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 Workm ' ' Compensation laws of California." . Owner g I Si ned -- -------------- -- ,� Title _� -- --�LA.Q- �``'------- --- ---------------------------- By ------ ------- ------- Y (If other than owner) I FOR DEPARTMENT USE ONLY i ----------- ------ -- ------ ----- -------- ----- - DATE _ � APPLICATION ACCEPTED BY _- ,- ----- ---- - BUILDING PERMIT ISSUED --------------------- ----------------------- --- --- --------------------------------------------- DATE ------ ------- ------- -- - ---------- ADDITIONAL COMMENTS ---------------------------- ---------- ----------------------------------------------------------------- - -- ------------------------------------- -------- -------------------------------- - ----------- ----------------------- ------------- - - - - - - - Date ---------------------------- - - -- --- - --- --- Final Inspection by: i SAN JOAQUIN LOCAL HEALTH DISTRICT F H- 9 1-'68 Rev. 5M -