72-887 - Laserfiche WebLink

Home Browse Search

FOR OFFICE IJsI=: APPLICATION FOR SANITATION PERMIT Permit -------------------- ------------------ ,., - Y ----_---------- (Complete in Triplicate) Date Issued ----- ---- -- --------h ` 1 _- ' This Pernii't'EXpiees I. Year-From Datelssued Application is hereby made to.the.San Joaquin Local,Hedlth District fora permit to construct.and install the work herein , described. This application is made in corriplionce with County Ordinance No. 549 and existing,Rules and Regulations: •-� - 'CENSUS TRACT _S:`--/--------------- .SOB ADDRESS/LOCATION -----1- '--F--f---4----. ' - --------- Pf � . •-_ _ d `---------------- -------- ------- Owners Name --------------------- itY -11- 4 Address --------- ----------------- Phone -------.License # Contractor's Name " . Installation will serve: Residence Apartment H#use,❑ Commercial ❑Trailer Court E] MotelOther--------------------------------------------- umber ---- ------- -------- -- -- - •- f Number of bedroorns Garbage Grinder --"-__----- Lot Size ---_-- -'--�-- --------------- Number of living units:----i----- `� � - Private Water Supply: Public System and name -------------------------------------------------- Character ---------------------------- - ------ - -Character of soil to a depth of 3 feet: Sand'❑ Silt❑ - clay ❑ Peat❑ _SdndyY,Loam ❑ Clay Loam, I Fill Material ---------- If yes,type --------------------------- F Hardpan ❑ Adobe ❑ r% I V (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) V NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer.is available within 200 feet,) --- Liquid De Depth ----=----------------.-•--- ' PACKAGE TREATMENT [ ] SEPTIC TANK:[ ] Size------------- ------ q p T Material== -_----------No-Compartments ------ -------- Capacity -----l;- --------- Ype -------------------- �l Distance #o nearest: Well --------------- Foundation ---------------------- Prop. Line ..- •----------•-- i ------ Total Length ------------ LEACHING LINE [ ] No. of Lines Length of each line --- ------- - • -------•-•---- D' Box ____'-.-__ T' e,Filter Material _--_ __Depth Filter Material - I '. ------------------------- - -- Foundation ------------- Property Line ------------------------ Distance to`-necirest: We ----___--- ----------- M Y� + 4 �"" " "_-7 Number ---------------- Rock Filled Yes [] No r❑ SEEPAGE PIT [ ] Depth _ Diameter ----------------- k Water Table Depth € ----_.------------Rock Size ------------------------- -•--- ----------------------------- l --------- •--Foundation -••--- Prop. Line -----•------------- Distance to nearest: Well --_-.-----"--------------- k J -) • ' -- Date ------------ -------------------- REPAIR/ADDITION(Prey. Sanitation Permit ----------- L �` ----------------- ----------e�� Septic Tank (Specify Requirementsi ----------------- ------- �,,� �p - --------------- -- --- __W_1 Disposal Field (Specify Requirements) ---- ------I 41`` - A"' ==s` _- '` 5 _ ---------------------------------- - - ------ � �(De.aw'ezisting and requir d addition on reverse si e) 1 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 Sari Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: " s permit is issued, 1 shall not employ any person in such manner I certify that in the performance of the work for which thi as to become subject to Workman's Compensation laws of California." Signed `- ----------------------- Owner - B --- Title r y � }' ------------------------ (If other trc - ner] ) -, FOR,'DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _. -- --------------------------------- DATE _ -�1---�'--------�----- BUILDING PERMIT ISSUED -------------------------- - ------------------------ ------DATE --------------'------------------------- ------------------------------------ - ' ADDITIONAL COMMENTS -------------------- ------------------- 7. ------- D =• -: -.:----- -- -- =- -----------------------------------------------. - - ---------- ------------------------------ -- - = -_:. -- ---------- -------- ---------- -- - � - - -------- --Date l�`---'-L-"7�- Final Inspection by: -/�/ - SAN JOAQUIN LOCAL,-HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M