72-442 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 1 - -- ------------------------------- --- Permit No (Complete in Triplicate) - ------------------------------ -_--------- This Permit Expires 1 Year From Date Issued Date Issued -7__7_L 'I I 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/LOCATION . �- t -` ma z . ......I�_CENSUS TRACT -------------------------- -------------- -i� Phone ��-`19/� ------ Owner's Name /-_��._/�__f-_�_��_.�-►-.f-�-�✓-�- - -�-+-------------------------------- �E-- --- Address _76--0/--------.5M---- 12 2fI/ ------ ------------------- CityM/?./V_ --------- Contractor's Name License -' 4D p------------------------- # - Phone / i Installation will serve: Residence E2 Apartment House❑ Commercial ❑Trailer Court ;❑ / i Motel ❑Other ------------------------------•------------- � Number of living units:._____--- Number of bedrooms _____Garbage Grinder __ -------- LotpSizef_______�_____------------------------- Water Supply: Public System and name ---------------------------------------------------------------------------------------------------------------Private ®. Character of soil to a depth of 3 feet: Sand'@ Silt❑ Clay ❑ Peat ❑ Sandy Lo m ❑ Clay Loam ❑ 1. Hardpan ❑ Adobe,❑ Fill Material --- ------- If yes, type ---------------- -_ (Plot plan, showing size of lot,tlocation of system in relation to wells, 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,l C PACKAGE TREATMENT [ ] SEPTIC TANK f ] Size------------------------------------------------ Liquid Depth ------------------- Capacity -------------------- Type -------------------- Mater' I- ------...... No. Compartments ------•-----------•--- Distance to nearest: Well ------------------------- Foundation -----;------------._ Prop. Line -----------------I...... i LEACHING LINE [ ] No. of Lines _______________________ Length of a line_ _ Total Length .______________.....__._.-_ M. D' Box ----------- Type Filter Material Depth filter Material ------------------ ------------ th to nearest: Well -_-----_- ___ Foundation - - ._-��_,__ Property Line ------------------------- e PIT [ ] Depth -�__________________ Diameter _ -___ ________ Number --. ------_____________.Ii.... Rock Filled Yes ❑ No Water Table Depth ---------------------- ------------------------R k Size ------------ ------------- ---- �] Distance to nearest: Well ------------- -------------------------- undation �._' ------ ---- Prop. Line ----------•---•----•-- i REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- ate -------------------I ---------_---) FSeptic Tank (Specify Requirements) -------- -------------- --------------------------------------------------------- ----h------ ----------------•=----------------------•--•- Dispos I Field (Specify Requirements) ------------------------------- ------------------ ------------------------------------------------- -------- J ---------------------- , / 71 ', dSf -, -ti ----- -------- ------------------------------ - -------------------------------------------------------=-------------------------------------------------------------. :.--------------------------- (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,l and Rules and Regulations of the San Joaquin'Local Health District. Home owner or licen- sed agents signature certifies the.following: / "1 certify that in the performance of the work for which this permit is issued, 1, shalt not employ any person in such manner as to become subjectVWVV*rkK 's Compensation laws of California." Signed -- - --- Owner BY ---- ----- ---- -�--- -� --------�--------------------- Title ----------------- '` ------------------------------------ -=--------------- If other than owner) / FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY `----01,ee•-�.K--------------------------- ----' DATE �T'� �"l� ------------------- BUILDING - ----------- BUILDING PERMIT ISSUED -----------------------------------------------------------="---------------------------------- ----- -DATE -------------•----------------------------- ADDITIONAL COMMENTS ---------------------------------------------------- =-I ------------------------------------------------------ -------------------------------------------------------------------------------------------------------------- ------------------------------ - ------------ ----------------------------------- --------- - I = ------ 1-.Date - -- Final Inspection by: ---- rte` --- --------------- �_ ----------------------------------- -- -- -------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 'E.,H.,.9 1-'68 Rev. SM