74-723 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: 160 q(p APPLICATION FOR SANITATION PERMIT Z ' (Complete in Triplicate) Permit No. --------------- ---------------------------------- ------��- --------------------- ------------------------------------ This Permit Expires 1 Year From Date Issued 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: f f JOB ADDRESS/LOCATION 1-6T 1 �-_ �_____S�LN O LA�__��'v_'G�`_. ��d1r CENSUS TRACT ------5�-_ Owner's Name ---------A1 1 3__V-------S r ll-------------•---• ------------------•------y-r-+_-•----------- --- ---Phone •-•---- Address C�_O O-----K 'Sow I--41--------------------------------- city l y_,4__ \ Contractor's Name -Of----ASI `1___h 0 r_------ t-�504V----___ _ - __.____ _.License # 3� -- Phone X -' I. `A Installation will serve: Residence - Apartment House❑ Commercial ❑Trailer Court Motel ❑Other ----.--------------------------------------- x _ _ -- --------------------------------- X /d�--' Number of living units:______ Number of bedrooms .__------Garbage Grinder ___________ Lot Size ._____.___________ _____________ D Water Supply: Public System and name ---------�'r-X----/�-�r.c-A---------------------•-----•------------------------------___-___-___-Private ❑ Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam Hardpan ❑ Adobe ❑ 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.) NEW INSTALLATION: (No septic tank or seepa "pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK'[ Size___ '� X 'xY"---------- Liquid Depth --------0-1-1 p Capacity _t om_____ Type 01 C-ASrMaterial__ b�G'____ No. Compartments -----a,............ 3 istance to nearest: Well ------------- /max /`� y LEACHING LINE [�/No. of Lines__________ Length of�e��h line/ _ Total Length____________________________ p 'D' Box ----�______ Type Filter Material _ Depth Filter Material --------------------------------� !�_ Rte' 3c� Distance to nearest: Well ------------------------ Foundation Property Line ------- Ic SEEPAGE PIT [ J Depth --------- ---------- Diameter ---------------- Number ---------------. ----------- Rock Filled Yes ❑ No 0 > Water Table Depth ------------------------------------------------Rock Size ---- --------------• ----------: �1 Distance to nearest: Well __-_____________________________ ___Foundation -------------------- Prop. Line _.__- ................ 4" REPAIR/ADDITION(Prev. Sanitation Permit# ------------.------------------------------- Date ----------------------------------) S Septic Tank (Specify Requirements) ---------------------------------------------------------------------------------- ------ ------------------------_--- 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 Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: a "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner r as to become subject to Workman's Compensation laws of California." S Signed , -------------------------------------------------- Owner 7k BY ------------ ------- ---- -- - ------------------------- Title -------------------------------------------------------------------- (If other than. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----75f-3=V_o----------------------------------------------------------------------------- DATE ------- f - ------------ BUILDINGPERMIT ISSUED --- ---------------------------------------------------------------------------------------------------DATE ------------ ------------ ---------------- ADDITIONALCOMMENTS ------ -- --------------------------------------------------------------------------- ----------------=----------------------=--------------------------- ---------------------- ----- --------------...-.--..-.- ---------- --- --------------------- -- -- ----- --------------- ------ ----- -- -- ,. --- -- -- ------ - ---- -- -- ------- --- Finallnspection Date SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M