SR0083210 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT /I 1 -----------------------=-------------------- Permit No..7.!...w (Complete in Triplicate) -- .4 ------------------------ This Permit Expires 1 Year From Date Issued Date Issued _.lA......_..__.. 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: JOB ADDRESS/LO TION — 7 e..-14 �__ P/._..- ` -•...................... CENSUS TRACT _-----•-_•-----._�...----. Owner's Name .- 071..-_.----•---- _..Phone ---- . ---• .... _ ..... ---------------•- Address %�-oov Ate- City• 2r Contractor's Name .._.__. ... . ... .. . .. ...... ._License #,1,d ..�Z-7�Phone .............................. Installation will serve: Residence portment Hou Commercial ]_]Trailer Court Motel ❑ Other��/-... Number of living units:----- _.-- Number of bedrooms ___Garbage Grinder ------------ lot Size __ ��-.,-�—. c-._..._ { 59 Water Supply: Public System and name-•••-•••••-•-••-••--•---•-•--•------------------------------------------------- Private depth of 3 feet: Sand'E] E r Character of soil to a de p ❑ � . tit ❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam Hardpan Adobe 1] 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 see ge pit permitted if public sewer is available within 200 feet,) J. PACKAGE TREATMENT [ ] SEPTIC TANK:[ Size `�...er_'�� .. Liquid Depth ....�_____________ }} oQ Capacity _L D._ (Type eml-- -y___ MaterigKlel-.¢,r__c_ No. Compartments o�.,.____�___...... i tance to neare : Well ........ FV.................... Foundation _4D_ `._........__ Prop. Line ..... �r..� .............. \ LEACHING LINE [ No. of Lines ..,,I ................ Length of each line____-5-,V---- ------------- Total Length .................. i D' BoxType Filter Material ..�---Depth Filter Material ....if ....---------.......... ti Distance t nearest: Well ------------------------ Foundation .....I.D...._.._..._._. Property Line ....-------------- SEEPAGE PIT [ Depth ___-S__�.... Diameter .. ��..f�. Number ....... ..................... Rock Filled Yes js' No i❑ Water Table-Depth ---------------.yip................ = ........ Rock Size Distance to nearest: Well .............. J.P-P.............. Foundation Prop. Line ... ........... t' REPAIR/ADDITION (Prev. Sanitation Permit.# --------------------------------------------- Date..... ................. .._.._...... 1 ( SepticTank (Specify Requirements)--------- '..................-•----••---••-•••••----------------------------------------------------------- f-.....----- -....... ... ----- Disposal Field (Specify Requirements) ---------------- I I - - ---------------------------- ---------------- -- •-----....... ----=- -----------------------------------------------------:------- (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: "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." Signed....................... --•----- ------------ ------ Owner �. BY--...._..--- ---- --- -- ` - ~Title ...... -- !%l/. :... (if other than owner) FOR .DEPARTMENT USE ONLY { APPLICATION ACCEPTED B ------------------------------------------------------------------- DATE .... - - -•---------------- BUILDING PERMIT ISSUED------------ ----_......._DATE _.......__..__.... _ _. -- - - ---------------••-- ---......_-......--•-••------••-• -- . _ ...........---••-•- ADDITIONALCOMMENTS-----------------------------------------------------------------------------------------------..---.------ ............ ---------- ...------......... ................................ --•-- ---- -------------------------------------------------••••--••---------------•-----------•------------------------------------------- -- -------- ------•------------------- - - -------------------------------------•-------••---• • • • •-- ••••-••••••... 7� Final Inspection by..=--------- ••-•---•••••---•--......-• Date --" V_-_--- ....... SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M.