70-792 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT .> 'Y (Complete in Triplicate) Permit No.7U "-7� ` This Permit Expires 1 Year From bate Issued Date Issued lU-- •7D 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 ._.__-j2<}1_t .0,- c: e---------------------- -- ------ ------------ - --------CENSUS TRACT _ v Owner's Name _ --------------------------------------------- - --- - --- ----- -- --Phone ------------ �------- Contractor's Name -----s ----------------------------------------------I— city .1`�d_�/,?`��- ---------------------------------------------- --------------------------------------------------------------- -__-- ------- ------ ------- -------- -------- -------License # ---- - :------ ------ Phone ------------------------ -•- - Installation will serve: Residence L'�Apartment House❑ Commercial ❑Trailer Court ',❑ Motel ❑ Other -------------------------------------------- Number of living units:- Number of bedrooms -___/------Garbage Grinder --- ------_- Lot Size Water Supply, Public System and name -_.__-_-_____- -" Pp Y� --------••-------- " - Private [a�------- ---------------------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 __________ __ __(Plot plan, showing size of hot, location of system in relation to wells, buildings, etc. must be placed on reverse side.# + NEW INSTALLATION: (No septic tank or sI ermitted if public sewer is available within 200 feet,) I PACKAGE TREATMENT [ ] SEPTIC TANK: - .f q p , � Size- --7�'�'��----�•2rs5-.Xtc�j -- Liquid Depth ---- Capacity _-!_ZC�------- "" Material-4 �-r-e} .No. Compartments - V� Distance to nearest -f__-___--_ -_------"-Foundation --__---5W- -------- Prop. Line --_u�-------" --- LEACHING LINE Ey-' No. of Lines --_ __ gth of each line---_ - ---- ----- Total Length -----14%_x2 ----""_--- Box _-_ TyprialQr 4- -----------Depth Filter Material __----/-1P f _"" _ _ ' / __ ----•--••-- Distance to nearest: Well _ .___--___-"_- Foundation "._ rlJ -- ---------- Property Line -"-�5 SEEPAGE PIT - --------••- �� E } Depth -------------------- Diame# ------ Number ----------------------- ------ _""- Rock Filled Yes � No Water Table Depth .----------- --- --=---- � -� - ---- Rock Size -- ----------- ----------•------ Distance to nearest: WellREP " t_.-"--_! _.__"Foundation - --- Prop. Line ------•----------- -------------- -- AIR ADDITION(Prev. Sanitation Permit�# _"-___" _. - - - ------ - - ---- Date ------- --- - --- Septic Tank (Specify Requirements) ---------------._,_ `- Disposal Field (Specify Requirements) -_- �. _ �" � Qm, " ------- ------------- ------------------- ` ---------------- -- ------------------------------------------- ,r Y (Draw existing and equired addition on reverse side} 1 hereby certify that I have prepared this application and that the work will be clone in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Nome 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 su-b act to Work mpens n laws of California." C `��` � Signed ------ �i.;y.�3� - -- - - -- � _ - --- -- ----- -------- --- Owner ---- -- -------- - ----- - - ------------- Title ------------------------- ---(If other other than owner) --- ----"--------- ----------------- FOR -----FOR D PAitT-MENT USE ONLY APPLICATION ACCEPTED BY ."___"-_ --------- , -----" _ _ t BUILDING PERMIT ISSUED DATE ----«"--?rte----------- ------------------------ --------------DATE -------------•-- -------------------------- -------------------------------ADDITIONAL COMMENTS ----------------- --- �-------- ------- -- ------------- - --------- ------------------------------------------------- -------- Final Inspection b ------------------------------------------------- ------------- �- } P Y - ------- SAN - ----- -- - - -Date ".. --- - -- � - - - -- - - ------ -------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M. �'`J