73-605 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMM v: .... Permit Na. ... . ' (Complete in Triplicate) --------- This Permit Expires i Year From Date Issued Dote Issued 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: CENSUS TRACT _S.-41............. JOB ADDRESS/LOCATION�.-10-13..---EY---�, TTS-•4s3.1�.............................................................. Owner's Name ...Mz'.....Smi.th.-------•--------------- ..........I...............:..................... Pgone ..931-2.j1.1- Address -- .9=.e..........------------............................................ ............... City ----------LA.d-i....................................................... Contractor's Name ....P-.ax-,kg -d-=-q---S-ept.IG...Tar-jjj�- -......................License # ....268.Q.51..... Phone 46.3-7.04.8........ Installation will serve: Residence-JZ] Apartment House 0 Commercial ❑Trailer Court 0 Motel ❑Other.............................................. Number of living units:_...*.1... Number of bedrooms .3.........Garbage Grinder ............ Lot Size ----------4... ............. Water Supply: Public System and name -------------•---••--•---------•---•....... ...................................../...........................Private E] Character of soil to a depth of 3 feet: Sand❑, . Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan - Adobe ❑ 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 seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK [ ] Size-------•----------------------------- - -------- Liquid Depth ................. r Capacity ------ --------- --- Type .............. Material...................... No. Compartments ...................... .I--,K--- - - w __ Distance to nearest. Well ------------------------------------Foundation ................. Prop. Line ............ LEACH ING.LINE- '{q No. of Lines --- -----------_------- Length of each line.........4.Q................ Total Length .... ............. rn L 'D'_Box .......I ape F_i_ltek M_ iite_riai .............2' ..Depth Filter Material ..........IV!........................... r Distance to nearest: Well --�.....�54s...�........ Foundation ---------20-'t-------- Property line ........5.0s.........P SEEPAGE PIT j Depth .._2_��__........ Diameters?3 -".. Number .....1.................... Rock Filled Yes [3 No C3 Water Table Depth 90.!....................................Rock Size ...2-•'-..........-............. ^% 0 Distance to nearest: Well ...........:0 .........................Foundation ........ Prop. Line ....?Q. Q' REPAIR/ADDITION(Prev. Sanitation Permit# .-.......................................... Date ..... ............................ SepticTank (Specify Requirements) -----•------------ - •--•..................................•----................................:..------------------------------- Disposal _Field (spec fy Requirementsl .t...L ach--Liffe$•&-- pit "X2�' a _� _ F................ -------------- ...... .................................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 o -San Joaquin Local Health District. Homa 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 ..................................................... •..... •••-•-•-f�---------------------- Owner By ......... - ....... Ct/a.rl -------------••----- Title ----------QOXI ra!✓-to.r._._.....__.......................... (If other than owner) 42 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .. .. .... .......... ...................................•--......--•-----.._.....__........ DATE .. ...� ..". BUILDING PERMIT ISSUED ------•--•.................••-......... - ----...---......-------- --•-- --_.._.......DATE --------------------------------- ........ ADDITIONAL -----•---------.-- - ADDITIONALCOMMENTS ......................................................................................._._._......................................:........................... ...............................................................................................................................................................•-••-----•-------............-•--••---•--. ....................................................... ................... -•--••-•--•----- •----•--_.._.-.-.-------............... M----------------------------- .................. -----•---------- = ...................................."....----._I.......'.................... Final Inspection by: .... .. Date 7.. .. ..3•• ---------------- SAN -- ----------SAN JOAQUIN LOCAL. HEALTH DISTRICT r. E. H.13-.24 1-'68 Rev,5M 7/72 3 M