73-7 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: j �= APPLICATION FOR SANITATION PERMIT _ ---------------------- �( (Complete in Triplicate) Permit No: ---_ _3 ___-----_.. ---------------------------------------------------------- This Permit Expires ?-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 4 described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION .— . _/ _ f� //I� _:_ G _/ � �c� ly. ` �f CENSUS TRACT 59' Owner's Name ------- /y---- � ��Q-y-�`--r•--y-- one -y--------------- Address --- -------- tee_ ; � _ -------------------------- Cityi1 p'4Y P Contractor's Name ___- _—� Ol�__ l��"1 Gly ------Ye---�� -- ---------------License #1 r 6-�`_-_---------- Phone t Installation will serve: Residence Apartment House❑ Commercial ❑Trailer Court ;❑ Motel ❑ Other Number of living units:-.-_r-- Number of bedrooms -_- --_-Garbage Grinder lVa--__ Lot Size _- -. Y ----...----- Water Supply: Public System and name ------------------------------------ Private, Character of soil to a depth of 3 feet : - Sand'1 Silt❑ � Clay ❑ Peat 0 Sandy Loam -E] Clay-Loam 0 - f Hardpan ❑ Adobe-E Fill Material NO----- 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 it permitted if public sewer is avail ab within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK ----------------- Liquid Depth --_--____----------_-_-__ � { ] Size-- --------•-•---------- �- CapacitY -t----------------- Type ------------------- Material---------------------- N Compartments P Distance to nearest: Well - ----------------------------------Foundation ------_- ----- ----- Prop. Line -------------:..------ LEACHING LINE -------------------_._ Length of each line-.___-----_---_ ` [ ] No. of Lines Tota! Length 'D' Box --A-------- Type Filter Material --------------------Depth Filter Ma erial --_-_---.-__--- - Distance to nearest: Well ---- ----- ------------- Foundation # - -------------- - - ---- Property Line, ---------------------•-- SEEPAGE PIT [ ] Depth -------------------- Diamet r -____--------__ Number --------------____--_- ---_ Rock Filled Yes ❑ No i❑ Water Table Depth --------------- --------------------------------Rock Size ---------- ------------------- Distance to nearest: Well --- - - -----------------------------Foundation __ Prop. Line ...............-._ REPAIR/ADDITION(Prev. Sanitation#Permit# -------- ------ Date _--_--_____-----_- -------------- Septic _ - __ ----------- - ------- Septic Tank (Specify Requirements) ,--------- --------- ---------------------- ------------------------------------------ •----------------•--------•• ; Disposal Field (Specify Requirements) -_----�/ A- --------/0_C�C4 4 ,. ��lo o- �s_-_f�� /� --------Amy -------------- /% f ` �''f`�/c-----_------------------------ ' - ----. (Draw existing and required addition on reverse side) 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, State Laws, anis Rules and Regulations of the San Joaquin Local Health District. Home owner or [icon- 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 Workman's'Compensation laws of California." I Signed ------ � H�_�!_!7& -r 4/ -------------------------- Owner BY -------- -- � -- ------------------------------------------------ Title --------------------- [If other than o er FOR .DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------ --------------------------------------------------------------------------- DATE BUILDING PERMIT ISSUED -------------------- - ---------------------DATE ADDITIONAL COMMENTS ----------------------------- -- ------------ ------------------------------------------------- ----------------------- :, -------------------------------------------- ----------------- --------- -------------------------- ------ -- - ------- ----- - ---- ----- - ----- - D eFina! Ins b --------- `--------------- ---------------- �--at ------- ---- -- ----------- SAN ------ -SAN JOAQUIN LOCAL HEALTH DISTRICT r E. H. 9 7-'68 Rev. 5M �1 Z9 a