73-979 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. -T3-....... ......................•....._...................... P Triplicate) i (Complete in tri lite /d_�I��••� ............................... Date Issued _.. ssued ................................. .... . -----._..... This Permit Expires 1 Yeas Fcom bdte E-I- nd l the work Application is hereby made to the San Joaquin n ec with Counal Health ty tOrdinance rict for a Na. 549 and existinrmit to construct ag Rules tand Regulationsf herein described. This application is made in compliance i r CENSUS TRACT JOB ADDRESS/LOCATION ............. .. -. - _T _ .. ........... ....Pho ... .......... Phone .. ...__...._..... .0. Owner's Name ...... ..:...... . i� ....... ��7 Address . .......:..:........ . q0 0 ---- city -�G'7 } - License # -� 3 �'.. Phone . .'. .. .. .. ' Contractor's Name ....... CAL -------• Installation will serve: Residence [Apartment House'❑ Commercial ❑Trailer Court 0 Motel FI-Other __: .. -------- ---•-- Lot-Size. _... ..... . [ Number of living units: .._ .....- Number of-bedrooms ' , ---Garbage Grinder_ ...... - �` _ ' ----•---- ---...._.. Private Water Supply: Public System and name .---.......-------------------------------- Character,of.soiI to a depth of_3.feet:__Sand 0- -Silt❑ - Cloy - lay -� Peat❑ andy,Loom.❑. Cla.y,Loam-0- T Yes, e ............................ Hardpan 0 , AdobE ❑ Fill es,Material;..,_,..-....)f, type --�� - buildings, etc: must be placed on reverse side.) (Plot plan, showing size of lot, location of system in relation to wells, NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) It ' T .. Liquid Depth ".J` _..... .... PACKAGE TREATMENT [ } SEPTIC TANK Size_.".. . .. . } • No. Compartments --01......... =• Material.._ p Capacity!:/W� . ---- Type � - S' eC � a: Distance�"to nearest: Well ��. ?`.. -"---....--.•._Foundation (.�.'�--•----- Prop. Line ...-•_--• -•--...... 'l len th of ch line .I. V ......:....... Total Length _I$ �_... • �1 LEACHING LINE No. of Lines -. 9 I'D' Type Filter Material 41<--.._Depth Inter Mdtenal _..I�.-. _.__....-- ��... . ....._. Property line f 5. to nearest: Well .... �. •---- --- Foundation ...... _... . ------ ............... . Distance Diameter ---•--- Number ..--- --. --.- Rock Filled Yes ❑ No C] N SEEPAGE PIT [ ] Depth t WaterfTable Depth .. T .....Rock Size .."--------------------- ----- Distance to nearest: Well _.................... Foundation _...., Prop. Line •--------------------- � r REPAIR/ADDITION(Prev. Sanitation Permit# -------- •.-.....- Date ----------------------- ) Ix -•--- •--.... I Septic Tank (Specify Requiremnts) .... .. - ---. -"........ ..... Disposal Field (Specify Requirements) ----- -----------------... ". " . ....._. . .......... . ............ ........ ...... "�" "` -'`"`'-n"'-__" _. -•.mi_ (Draw existing and required addition on reverse side) t the work will be done in accordance with San Joaquin I hereby certify that I have prepared- this application and tha County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- i sed agents signature certifies the following: "I certify shat 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 Wor an's Compensation laws of California." r Owner Signed - - - --=--� - -- .. . ".........-•- --...... "-------------•----------• "-------- L- -------------- ------ ------ Title ".---•�- .......... ............. I other than owner) FOR DEPARTMENT DISE ONLY APPLICATION ACCEPTED BY .................... ......"- --- --------------- DATE .... BUILDING PERMIT ISSUED .. ... ............ . DATE ADDITIONAL COMMENTS ................."..... ._._ -1---- .... ---- --.• .............. . ----•---•• •.................. ........ .......Dote Findl.lns ection b SAN JOAQUIN LOCAL HEALT ISTRICT _ 7/72 3 .K F _ .. i 'l '1 Lc • :ten n__. rll � -