73-511 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR .SANITATION PERMIT .........- i + Permit No. .. 7173— 1/ (Complete p to in Triplicate) _...........................€....I.............. This Permit Expires Date Issued .......11`....• 1 Year From Date 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, .i. -c• .:.....................CENSUS TRACT .._ JOB ADDRESS/LOCATION .....��7.�,--�t�. ---.. _ ....- . Owner's :Name .......................t'l'®t�fi" i c3r�3. .................. ........... = ....... =_ Phone _ � Address ._ C :_..: ;y' .............. :....:.. I S - S 3" ... .7 f ----------------L-iceiise # Phone - Coritroctor's'Narne ............................ i Installation will serve: Residence Aportmerit•House❑ Commercial ❑Trailer Court ]] - .. _ Motel ❑Other......... ......... ► ,. K , s Number of living units:..- Number of bedrooms :'3.......Garbage Grinder ---:77J......!Lot Size ............. .................... Water Supply: Public System and name .._.�..--------:-'-.-•_. -4�--- r .. _ -A ivate ❑ � of 3 feet: _' Sand❑ Silt❑ Cloy ❑ Peat❑ Sandy Loam ,':Clay Loam t9Character of soil to a depthHardpan "Adobe'0'"F111.Matenol 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" ermitted if public sewer is avoilabl within 200 feet,], Liquid Depth ...... PACKAGE TREATMENT-_ ( } SEPTIC TANKf ] Size..... ....................... ............. q p Capacity • ....-------•--- Type --• --------------- Material........................ No Compartments.r... l lir'-•.�--.,o. 1 _ _ _., 1• � i Distance to nearer . Well ...j.-_..A..-:- I .. "+..Foundation .......... .... .. Prop. line ..... ..-. ...- LEACHING LINE [ ] No. of Lines.----- --5.............. ength-of-each line-----.._--_.......,.-.-:..._ ota1 1 7n th _.-_._........_- ... ^'D'"Box- :� ype-Filter teriaf --.._. :Depth Filter Mat rial .. '............... . .......:..' _:.. y l .- .. a �- Distance to ,nearest: Well :........:...... Foundation ...- ..:.:_ _ Property tine SEEPAGE PIT [ j• Depth ........ .......... Diamete ;................ .N-umber ...--..--._ ..... Rack.,Filled Yes C] No Q • Water. Table Depth .. = '....... .............Rock Size .......... ........ . _ _.__ ' +__•• A Distance to nearest: Well Foundation ....:--- .....:.... Prop 'Line • _• REPAIR/ADDITION(Prev. Sanitation Permit# �.. :... . ........................ Date ............................ __ .............•................ s Septic Tank (Specify', Requirements t ) -.-.... .4. ............. .r......................r sa f I Disposal Field (Speicify Requirements[ .. _._�L.P. i.-- .j` �•• ... .... •---- -•__-.• ....... i.�-�r -µ--~`J '`�-`- .... ------ -- --- -------- -------- --------- •----- f (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 laccordance `with Sart Joaquin Courity'Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- § sed agents signature certifie s_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 syblfct to Workman's Compensation laws of California." Signed ..... ...... ................... ...... •-•..........-•-----•------• Owner � .... .....�..... [ .......... ....... By .......:....h-ry. -- ..- •-- ..... .. T- (If other than owner) _ mm FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .....�i. . ........:...... A:✓� DATE � - '. LlI LDING PERMIT TISSUED _ - ... -.. ..DATE T.-�:... .... B =.. TISSUED ...................... ............. ............. .... ADDITIONAL COMMENTS .......:...... :, _,..;.... _:.._............................. ...__. .... --- -• ... .... Final Inspec - -----. - -._. , Date , L SAN JOAQUIN LOCAL HEALTH DISTRICT r I L, 13 24 1 -,-e n_.. GAA — -- - 7/72 3'M