72-1089 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT __ Permit No. _7 .-Z44 (Complete in Triplicate) -- --- • _ Date Issued __�. This Permit Expires ] Year From Date Issued Application isherebymade 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: E JOB ADDRESS/LOCkTIONy® / /� ' .CENSUS TRACT -------------- -------! " Owner's ---- Name _.f +J ® l /5 ( c----------/--- ...Phoned'd-2 p� -- ------ NIet --- --------------- city . -,/,Pory\/----------------------------------- Address __�. .-L✓� � � wry Contractor's Name -----�'`�__.-'•- __-- - -��--1---�''h --- License #o` y/_ Phone a-D` Installation will serve: Residence ❑Apartment House Commercial ❑Trailer Court ;❑ Motel ❑ Other -----G/v--------IJavv-e--- i i` Number of living units------------- Number of bedrooms ------------Garbage Grinder ------------ Lot Size ---...--__.....---_-...__----------------- E Water Supply: Public System and name -------------- Private K Character of soil to a depth of 3 feet: Sand'l� Silt❑ Clay El Peat E) Sandy Loam •❑ Clay Loam.F _ a _ _ _ Hardpan ❑ Adobe F-1FillhAaterial ...______.._ If yes,type ---------------------------- fl (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEVINSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TAMC f ] Size-----------------_.._---.---- - -------------. Liquid Depth .__----.-.---------.----• Capacity ------------------- Type --/he -------- Material ----------- -------- No. Compartments ------ ---••---------- \ Distance'to nearest: Well --- ----- ----------------Foun tion --------- ------ Prop. Line ------------------_--- I LEACHING.LINE [ ] No. of Li es __------.-------------- each line...... ---------.-_-.------ Total Length ,.._.------.--..------------ 'D' Box ------------ Type Filter M --------------------D th Filter Material --------------------.-----------•------Distance to nearest: Well ------ --------- Foundati n ------------------------ Property Line ---------------•--------SEEPAGE PIT [ ] Depth .- 1---.-..._...._ Diamete -_. Numb -_--- -- ---------------- Rock Filled Yes 0 No 0 Water Table Depth --------------- ------------------------Rock Size -------------------------------- Distance to nearest: Well ------- ------------- ----------Foundation -------------------- Prop. Line ----•--•-------------• 1 REPAIR/ADDITION(Prev. Sanitation Permit# ---------------------------------------- ---------------------------------- -`- --- Date -----------------------.----------) t r ` Septic Tank (Specify Requirements) -- �Q /� � �f. e------ d 1-------------------------- ------------------------------------- Disposal Field (Specify Requirements] �___-�-------•-----� - --------------- -----�" ----------------------- -- _ . (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 accordance with San Joaquin 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, I shall not employ any person in such manner as to become subject to WS*Pan's Compensation laws of California." Signed ------ - --------s-----�----------- -------------------- Owner By ------- -- —------------------- - l�Lf `' ----------------- Title --- ------------------------------------------- ----------------------- (If other than owner) FOR DEPARTMENT USE ONLY �} APPLICATION' ACCEPTED BY ----7-1 (-h-,0-------------------------------------- ----------------------------------- DATE ---IGS -- �'-- _Z�-�'r_ BUILDING PERMIT ISSUED - - -----DATE --------------------- ----- ADDITIONAL COMMENTS ---- - ------- -------------------------- K - - ------------- ------------------ -------------------------- ----------- ----- ----------------------------------- --------- '------------------------ ---------- --- -- ------- - -- ----------- -------- - ----- --- - --- --- - ---- - -- -- '- --- --'- -----------'------ ---------------------- --.�-- --:r Final Inspec r--------- ------------------- Date -------------------- --- ----- - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M.