74-5 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT S' 4. Permit No. ��~.._.._..... ........... ......................... ••...- -• (Complete in Triplicate) ............ Date Issued !' '7 � -.- This,Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein 5with County Ordinance No. 49 and existing Rules and Regulati described: This application is made in compliance ons: `'aT�f ►��e r�.�.�7. .• .----..CENSUS TRACT ......�'r.r7.:. JOB ADDRESS/LOCATION .-5.•%�¢ X9.57`..^ ' / 1 .....................••......•••............. Owner's Name ./..<.(..U7��-• /C'f�/LGt_iYzo.:?�o._.. ................................................. one ..._............_... - .._.. City .�.Qq.1----------------- Address J�F}L2�.ti! -................ .................. . p ' Contractor's Name _. -!/�R'n �:`l 1Q- _................----......License #oo.pS �-7_. Phone,3 Q•. Installation will serve: Residence [(�Apartment mouse-❑ Commercial []Trailer Court :❑ Motel ❑Other ....... --- - .3------Garbage Grinder ..�-es. Lot Size . -�T. 1��--......•........ Number of living units:.......,..- Number of bedrooms _.. Water Supply: Public System and name •-----._. . -------------------------------------------Private Character of soil to_a depth of 3 feet: Sand Silt 0 Clay El _Peat 13Sandy Loam El Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material ._.. ....... If yes,type ------ (Plot plan, showing size of lot, location of system in relation to weils, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) . SEPTIC TANK SY PACKAGE TREATMENT ( } ize..-..�----a-.Q...... ................... Liquid Depth ... �..._ material No.No. Compartments _2a.� -----•-•— Capacity �I r.�..6.0.. - Type -- � Foundation .. �.....---.. Prop. Line ..4�..----.._ Distance to nearest; Well . .1 -------------------- t S LEACHING LINE [ ] No. of Lines ... ..... Length of each line .... A69............... Total Length .... .........O 'D' Box Type Filter Material __ QG-k-.---Depth Filter Material ..._........--------------- ---------- Distance to nearest: Well ..i�.0_...___.._.__ Foundation .p .--- Property Line . ............. . � ----..... Rock Filled Yes ❑ No Q SEEPAGE PIT ( ] Depth Diameter --- -----------• Number .....-.- .......... - Water Table Depth _ . . . ...... � Ems• Rock Size P .... ....... ....... Prop. Line ................ Distance to nearest: Well ----------------. - -- IDate _..---------•--------------••-----) REPAIR/ADDITION(Prev. Sanitation Permit# -------- ---------------- ------- Septic Tank (Specify Requirements) ......................------------................. Disposal Field (Specify Requirements) ------------- ................. ......_.. -•--�-•+fes._ _. „� ..ce---• ......... ... ................... . . ... �... ......... -- ..... - (Draw existing and required addition on reverse side) ll be done in accordance with San Joaquin I hereby certify that I have prepared this application and•that the work wi County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District, Home owner or Iicen- sed agents signature certifies the following: "I certify that in the performance of the work for which this.perrnit is issued, 1 shall not employ any parson in such manner as to become subject to Workman's Compensation laws of California." j Signed .:.. .................. --•.... • ------- Owner BY _. - ,Title .. ................... ........ (If other than owner) FOR DEPARTMENT USE ONLY I APPLICATION ACCEPTED BY .- , `d - DATE .�.�. ..._... ._.*3.............. " ��--�................... ._,_......._._DATE ......_.........---••--••-•-• --------.:._. BUILDING PERMIT ISSUED .----•-•-'.------....._..._....... ......... . •---•-......... ADDITIONAL COMMENTS ........... ....... .... ..•-•- •. - .....-- - -•.... .......... ........................_. ....... ........... .. ......... - .� ._ --- --_._................--- --._ .. -_--_ Date .d_'. . ._.._.... Final Inspection b ------ SAN JOAQUIN LOCAL HEALTH DISTRICT 7/723 , ru -