75-75 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT �........�"" " ! ..................... Permit,::.. . (Complete in Triplicate) No. ... '- " ........................................................ � This Permit Expires 1 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 County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ..........................................CENSUS TRACT .......................... Owner's Name ....A ......,�.. � .c'.d. 4,P- ._ .............................................................. ..........Phone Address ... 67..... '.... City / . Oil Contractor's Name --_- Z9 .4 ----_-..............................License # .r Phone Installation will serve: Residence ❑ Apartment House 0 CommercioloTraller Court ❑ Motel D Other _0x.':•A1r,1 .1AA . ..5 -.; /arV Number of living units-:............. Number of bedroom`s ............Garbage Grinder ............ Lot Size ....--_........................... ......... Waters Supply: Public System and name ..... !........ ..............................Private ❑ Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay ❑ ' Peat❑ Sandy Loom ❑ Clay Loam ❑ Hardpan ❑ Adobe% Fill Material -------__::_ If y0es,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.permitted-if public sewer is available within 200 feet,) PACKAGE TREATMENT SEPTIC TANK Size.__ ... j pi {' �. . ....................... Liquid Depths:......._._._....... Capacity .... Type, P� Material., &rrf °_. No,' Compartments .... ............ Distance to nearest: Well __......... .Foundation _../.. 1....... -�lane : LEACHING -� LINE r No. of Lines ...... .._. Length of each line.-- ' h ................. . ..._.._..__•-- Totdl.Len t 'D' Box�t--._ Type Filter Material/0 /�� . Depth Filter Material" _" ._�.................��...:.:..: F, Foundation :�_..__..._.__ Property Line .. ref.............. Distance to nearest: Well _-._.._.•- ...... _ BAIT TV Depth .-f-------------- Diameter _. _.. Number _...,/........_.....___.-_: Rock Filled Yes,,C No Q Water Table Depth ....... ~ ....Rock Size / -0;e Distance to nearest: Well -------- .........:........Foundation __/r°f�`�..:---- Prop. Line :�W---....-.---..- REPAIR/ADDITION(Prev. Sanitation"Permit# Date ' -"' ~ SepticTank (Specify Requirements) -----------------...........................................•...........•..........................................._................. DisposalField (Specify Requirements) ---------•• --• _-_---• .......... .............--------------........................... ............................---•__•------- ---------------------------------- ------------------------- ----------•.......................................... ---------- ---------- -------------- - ....................................................................................................................................... .. (Draw existing and required addition on reverse side) 11 1 hereby certify that I have prepared this application and that the work will be done-An lcccordance with San Joaquin County Ordinances, State Laws, and Rules and legulations of the San Joaquin Local Health District. Home owner or Ilcon- sed agents signature certifies the following: A "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 subject to Workman's Compensation laws of California." Signed .......................' ----------------...,r- ..........................._ Owner BY ............... .. ---- ---------- Tit e .- �!y. .C'�C......-- ••---._............. (If othe an owner -------------- FOR DEPARTMENT SE NLY APPLICATION ACCEPTED BY ............................................. -• r,... DATE ... ................. BUILDING PERMIT ISSUED ' ...DATE ADDITIONAL COMMENTS —_,- .....................•-----.---- ...__._.._._._..._..-'__ .� ---...__--------------------------------------------- _.._.---•-----------------' . --------------- -.----------- ........ _.................................................I................ 4 ....------------------------------------........._.--•-•---• -•--_-_... .. ..........___ ................................................................................................... ............ ................................... ..... ._ ..... ......... .......... Final inspection by: .....--•............ .. .... .. ------ --•---•--......Date .....�_-�._._._��.�_...._ SAN JOAQUIN CAL HEALTH DISTRICT F- H- 13 24 I.-AR Rpv KM 7/79 -3 M F