74-55 - Laserfiche WebLink

Home Browse Search

Oil OFFICE USE: _;► APPLICATION FOR SANITATION PERMIT. _ 1 r ' �: 1 Permit No. _ x '[; lCompl'ete-m Tnplriatel ��'..., --- ---- n 1. -., .�, ' . Date"Issued .a'`�__ ;' This Permit Expires 1 Year From Date Issued' -- `k------., --- --_ =k....._ r ZoB--?moo-f Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein made in complicince with unty Ordin nce No. 549 grid existing Rules and Regulations: J. :7�_:7k "c{ibed:This application-'is 1 �s I y —'� -CNRACTB ADDRES �LOCA _ c:�iY•4' _ _ SUS one Owner's'Name ---flar,"j., � - - - -------- - - -- --. - -----------------------------------� Ph- .6- - - --------- <. . c. Address ----�� E---- - - - -1, -- �-=`s-�.�I`-�--------•----- ----• City --- 3 - - - - - ------------------/------------ •---••- r ContFactor's Name ` /# t ------ • -=-=-License /- Phone __�- - # 1. Installation will serve: -'Residences Apartment House'❑ Commercial :❑Trailer Court 1❑ / . T • Motel ❑Otheti - ---- ----------------------------- , Number of living units..__,._/_.Number of bedrooms' __ Garbage Grinder _ _____ Lot Size _.___ - -- Garba Water Supply: Public•System rind name - ________ ____ _ _ - -g---it----- -----------{;--------Private r r Character-of soil-to a'de +h of 3 feet:Ha�nd Silt D Clay E] Peat❑ Sandy Loam ❑ Cfay Loam;❑ r paf] Adobe,[] " Fill Material ------ If yes,type -------------- ----------- (Plot plan, showing size of loti location of system in relation to wells, buildings, etc. must beplaced on reverse side.) I NEW;INSTALLATION: (.No septic tank or seepage pit permitted if public sewer is available witF in 200 feet,) PACKAGE TREATMENT.,f-] SEP' - ------- ----------- f 1 ----------------- -. �.IC TANK-[ ] 7 e -- -_ ire _ Material__��cr � No.;Liquid Depth _____�• t . ., Capacity ��!_Q yp P �Z- x� Compartments =-..;.Dis . o - Len &a---------- - =Foundation ----- - ---------- Prop. Line -----------ate__-------- LEACHING LINE [ ] Not of LirieS nearest.. Well X' ;gth.of each line=..... t9_-------------_ Total Length �F ';D' Box Type Filter��Material ------_1�__--------Depth Filter Material -____'f_T___ __________________ ----- Di--stance to nearest: Well -__ Foundation ------f0----fr___.___ Property Line __--- -.-.-- - SEEPAGE PIT [ I Depth _ = y"""" _�Diameter Nu Size -------------------------------- Distance' """ Rock'Filled `Yes ❑ No .i[]_ I . R.�.. =-- ---- Water Table Depth �'•'"""' s Distance to newest: Well _- _------- 'Foundation ------ Prop. Line ............. ........ is REPAIR/ADDITION(Prev. Sanitatioh Permit}# _----:`-;--_-----------+-�--.�-.-�---�yr-a�y--------- Date ---------------------------------- s Septic Tank (Specify Requirements).}--------------------------------- --------- --- = - ... F Disposal Field (Specify Requirements) ------- -------------------------------------------- --------- -------------- ---------•--------------- - ,�,,,� •�. -------------r----------------------------------------- •------------ ------------------- ''-- . -' - -- - - - --------- ------- - - -------------- --------=----------- -,; --------- ----- -(Draw,exisfin--- _Q�� required addition on reverse---------------- ------------------~- ------------- I I herby certify that I have prepared.;'this application. side) - - - -- ion.and;that the work. will -.4e done in accordance with Son Joaquin County Ordinances, State Laws, arid-Rules and 'Regulations of the San Joaquin Local Health District. home owner or licen- sed agents signature certifies the following: fes:"s "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 Workman's Compensation laws'of California." f I ------ - 9 - Owner By - - - --` , - - - -- ------------=---------------- = Title --------- ------§------------------------------------------------------ (If other than ow r} " ' 1 ) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED„ BY # _. - =-, . "---------------------- DATEa BUILDING PERMIT ISSUED ----------' ---- ----------------------------------- ------------- ------- --------------DATE --------------------------=---- -•------ ADDITIONALCOMMENTS -----------=-------=--------------- -------------•-------=-•=----_ -- ---------------------------------------- ---------------=------- -------- 4 - . ------------------------------ --- ------------------------ --- ----------------------------------- - --------- ------ ---------- 1 f ____ ____ __ __ _________ _ Final Inspection by. : .-. + -- ----- --- -----Date -------- - - '-- -- - -------- SAN - --- SAN JOAQUIN LOCAL"HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M