72-532 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: R .: APPLICATION FOR SANITATION PERMIT -------- --- -----=------ ----------------------- i {Complete in Triplicate) Permit No. ------------- -------------------------------------- '� This Permit Expires i Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct arid' install the work herein [ described. This application is rrrade in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION __ _i_76 ____ ----WO/V _ _ .F-------------------- -- CENSERS TRACT --J-`- ----•--- Q - f I TN V�ti _ 17 - - --Pfidh-e Owner's Name / --- Q � = - Address -------- ja3.15Q-------a-------A_ - -.EN---------------- f Contractor's Name ---QINI A-------------- f i --------- !__t i_ Licen e # Phone ------------------------------ Installation will serve: Residence R�`<Partment House❑ Commercial)❑Trailer Court ;Ej Motel D Other Number of IIvin units:._._____._ Number of bedrooms __ f g :_Garbage Grinder - ---------Lot-Size .___ ___ Water Supply: Public System and name -------------------- --------• -- _.t—_,.,, .;___-�-------- �. Private rivate " Character of,soil to a depth of 3 fee#: ' Sand' t ""Cfa { 1 p ❑ ❑ y;"0,:7 Peat ❑'- andy Loam Clay1 am ❑ Hardpan Adobe E) F;ill;'N4dterial _______.� If yes, tyle ......_____ �_____ I (Plot plan,fshowing size oflot, location of syst m 4 rela#ion to wells, buildings, .etc. m st be placed on reverse side.) NEW INSTACEATION: (Oseptllc tank or seeps a pit permitted if public sewer is availab within 200 feet,) I PACKAGE TREATMENT [ ] SEPTIC TANK f ) t Size_______________ Liquid Depth ________________________. \ ----------------- ,,, V i Capaci Y T e - Material ------- o. Compartments i Y Distance\to ,' arest- W ll ------------------------------------Foundation ------- -------------- Prop. Line ----------------- k'. LEACHING LINE ( I No. of Lines�1-___________ ______ Leg of. each line---------------------.__-_ _ Total Length _. I Box .--------- Type Fi ter Material_____________________Depth Filter M terial ________ ____ ------------------------------ Distance to nearest: We l______________ _ ________ Foundation j___________._____ _____ property Line ,_r..- ------------------------ SEEPAGE PIT! [ ] bepth ____ _______________ Di meter _______________ Number ___ _________________ _____ Rock Filled Yes ❑ No i[I 111 i Water Table Depth -- Rock Size _ g _______..__ f i I �'�' ) -istonce to nearest: We € ` F Foundation .. t Prop. E'rn` ------ REPAIR/ADDITION(Prev. Sanitation Pe it# -------------------------------------------- Dater---'-----y'� ------------____-) i. Septic Tank (Specify Re uiremen - -------- Disposal Field (specify Requireirnents) �/ 7,f}tC,t,.' 7 //_ �•- -----��.�-cam ---.�1.1�� •.". -- �--- — µ--=-,----�• - -- ----- --- r �'r7- (Draw existing and required additiomon reverse side) t° r I hereby certify thatrf;have prepared this application and that the work`will be done in accordance with San Joaquin ,.. County Ordinances, Sfbte Laws, and Rules and Regulations of the'San Joaquin Local Health District. Home:ovr�.or licen- sed agents signature certifies the following: "I certify that in a performance of the work for which this permit is issued, I shall not employ any perscrn'in such'Mr artiner as to beco ject to 5Wman"s Com ensation laws of California." Signed x E � --------------------------- Owner r By ------ --- ---- ------------ - C Title i ---- R.- ;(If other than ow _ :�', "r ----------------------- FOR -- ---------" -------' s _ FOR DEPARTMENT USE ONLY f APPLICATION ACCEPTED BY .-- " ----- --- -------------- - DATE `_ _ -- BUILDING PERMIT ISSUED ............ p--------------- DATE -------------------------- --------._ ADDITIONAL COMMENTS --[_ _=-_- , -.:- -:-— - _� - ------------------ ---- - -- ------- ------------------P�7 ------------ ---------- --------- - ------ - --- r Final Ins a _PAX' __ Date - � �� 1 SAN JOAQUIN LOCAL HEALTH DISTRICT . l E. H..9 1-'68 Rev. 5M x