75-827 - Laserfiche WebLink

Home Browse Search

OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Triplicate) .................................................. I /� /7 �Sf -,_„--....., 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 and install the work herein described. This application is made in compliance with-Co my Ordinance No. 544 and existing Rules and Regulations: �L . ` - J �.....JOB ADDRESSAOCAT -CENSUS TRACT ........ ............ Owner's Name ............................... ._..Phone ................................... Address ...-----.•............................... 1 : �._ c,ct' C- .: .. City Contractor's Name ...... _.: --.f-rr... ._ � '� ------...__._.License # ..( 3?.?. Phone .............................. Installation will serve: Residence ❑Apartment House Commercial ❑Trailer Court Motel ❑ Other _.r'�'�-°`”"L!.._//r''-- Number of Living units:_..f...... Number of bedrooms ----.Garbage Grinder ............. Lot Size ....44- -t--r- - ---.... Water Supply: Public System and name ----------------------------- - -------------------------------......._. ---------- ........Private Character of soil to a depth of 3 feet: Sand [] Silt E] CI( Peat F] Sandy Loom ❑ Clay Loam C3- � 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.) i NEW INSTALLATION: (No septic tank or see ge pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ } SEPTIC TANK I] Size.. .. / .- ___ �� ..�_.... Liquid Depth ..... ................. Capacity -I_rte....:L.... No. Compartments ....... ....... Distance to nearest: Well .......... .G'..f.............Foundation Prop. Line .....S .- . ._. LEACHING LINE No. of Lines -----.�............. Length of each'line._______re._-:._.___-_ Total Length ... ........... j V ...............Type Filter Material .:.._.__ :f.Z....Depth Filter Material ------..:_ S Distance to nearest: Well ........1`•.1 .......... Foundation .....1.j�.............. Property Line ..... SEEPAGES PIT [� Depth _..._ ._�....._. Diameter- _—: `r Number ..___.:::.. __.__..... Rock Filled Yes I Na ❑Z Water Table Depth .. ...Rock Size a f X 3 4 Distance to nearest: Well ......... 0------_..............Foundation Prop. Line .-S.............. REPAIR/ADDITION(Prev. Sanitation Permit# ----------------------------------------- Date .............. ..._.......__----) � SepticTank (Specify Requirementsl............................•---------- ................... .............. ........................................... ...................... DisposalField (Specify Requirements) ----------- -----_---------_--------•- ------------------------------------------ ..---.._..._...----------------._............- ------------------------------------------------------- --_-------- ...... --•----------------------• --------------------------------. - i •_ __ .- ............................................____........ 5 _ _ ____________________________________�..._...____._._._......__ �r I hereby certify that l have prepay [Drawexisting and required addition on reverse side) t ed this application and that the work will be done in accordance with San Joaquit- County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen-' sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed .............. _. ----------- ...... Owner By .._..... �l�ca:� (/ Via.. �= ;title . 17 :Ct!s................................... ...... . (If other than owner) FOR DEPARTMENT USE ONLY ......... DATE ..�5.............•••-- APPLICATION ACCEPTED BY ........--•._..... -•-•....................... .... .. BUILDINGPERMIT ISSUED .... ........... .. ._....-•=-•--...........................------ ---....DATE -------.....-- ...................... ADDITIONAL'COMMkNTS ...._..e .,lr? Q ... . .......................................................................:--_------------_......... ----_------- .... ..... ....................... '--- -------------I.........- r .................................................. ..................... FinalInspection by. .................... ------------------..-----......................,;..................................... Date �t�. !f�/ �.--.._......_._.... SAN JOAQUIN LOCAL' HEALTH DISTRICT E_ »_13.-241.'es Re, 5M 7/72 3 �K f d