72-1112 - Laserfiche WebLink

Home Browse Search

f FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. - -�/��- ---------------------- - ---------------- - (Gamplete in Triplicate) ----------- ------------------------ Date Issued --��,��"• . This Permit Expires 1 Year From Date Issued Application is her ma a to the San Joaquin Local Health District for a permit to con truct and install the work herein described. This applicati n is made in compl' nce wifih County Ordi nee No. 549 and a fisting Rules and Regulations: _CENSUS TRACT ___ --------------- JOB ADbRESS7LOCAT! N ITtw`" _ f ' d4_RIAS K�.__�'�J�-S4'_k--------------------- --------------- - Phone Owner's Name ----------------- - �a�_ ' Cit - --------------------------------= Address -------------------=----�_��)-----44�.�1��-�-- ��'------------------------ - Y '----- �------------------- --- Con#ractor's Name ` -------.License # ------------------------- Phone ------------------------------ Installation will serve: Residence ❑Apartment House❑ Commercial :[Trailer Court ;❑ Motel E] Other ----IIAW-&MC__ ___________g_'e Number of living units:_____f___._,Number of bedrooms --3------Garbage -1- Lot Size -______(71 '$----------•-------- Water Supply: Public System and name ----------------------- ----s - ------------------------------------------Private �' I Character of soil to a depth of 3 feet: Sand'El Silt❑ Clay ❑ Peat Ell Sandy Loam El Clay Loam :1� Hardpan E] Adobe.E] Fill Material ------- If yes, type --------------------------- 4 (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc, must be placed on reverse side.) W NEW INSTALLATION: JNo septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANKSize------------------------------------------------ Liquid Depth ----- ? ------------- Capacity _13!04 ------- Type `I18-(&51---- Materiai_�. ��-�__ No. Compartments --------------- Distance to nearest: Wel! --- 49,00-1 -----V)----------- Prop. Line -/n0------.------ LEACHING LINE ( ] No. of Lines -------3------------- Length of each line.______-Q-------------- Total Lengths _1_ _________________ 'D' Box `eS____ Type Filter Material rs_J _.Depth Filter Material --------- _�_!�--------------------•-..-- Distance-to,nearest:-Wel! ____, ----------- Foundation ------------ Property Line ----------- -- --- - -- SEEPAGE PIT [ ] Depth ___________________ Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No i❑ Water Table Depth ------------Rock Size -----=-------------------------- Distance to nearest: Well ---------------------- --Foundation -------------------- Prop. Line --------•------------- REPAIRfADDITION(Prev. Sanitation Permit# ----------------------------------------- Date __--____---_-----.----------------) 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 sign ature'certifies the following: "I certify than 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." S�Igned- --------------- ----G ----------------------------- Owner By -�`' ' - ------------ Title ------------------ ------------------------------------ ------------ �! (f o r fih owner FOR DEPARTMENT USE ON Y APPLICATION ACCEPTED BY --_------- DATE yr7 A ------------ ------------ -------- - ---- - - BUILDING PERMIT ISSUED ---- - DATE ----_"--- ----- ------------ t ADDITIONAL SCOMMENTSU� _ G . .rte �L 4.� ------- "" 1 =- �# ----------------------------------- l�"=_ ---------------------- ---------------- -------------- ------------------ ---------------------------------------------- ------------------ - ----------- ----------- ------- - -----.Date ---------- -__ Final Inspection b SAN JOAQUIN LOCA TH DISTRICT E. H. 9 1-'68 Rev. 5M