72-694 - Laserfiche WebLink

Home Browse Search

a-FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT --------- ----- ----------------------------------- ... _ Permit No. (Complete in Triplicate) ____ __ _ y __ ___________ This Permit Expires 1 Year From Date Issued Date Issued A i5 ppIication �$ereb y�made,'fo 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 ----- ------------------Phone ------- Address - J.5_'----- [ � ----------------- City --- -----------------------------------------------• ., Contractor's Name _. __ , 1 E,G____ _.License # ---___----__.____._ Phone - - Installation will serve: Residence ❑Apartment House❑'Commercial'[:]Trailer Court X Motel ❑ Other ------- ------------------------ Number of living units-M.0-__ Number of bedrooms ___________Garbage Grinder ------------ Lot Size _ f. ._ ---______...__- Water Supply: Public System and name _______________ ----------------- f r ---------------•------------------------- -- ---- --- -�- ----------------Private Character of soil to a depth of 3 feet: annHa Sdn❑Silt❑Clay de 0 Material � _.____ if es,type ------- Clay Loam ❑ ,Peat Sand Loam j -_.Mot plan, showing size of lot, location of system in relation to wells,':buildings, etc. must be placed on reverse side.) LV NEW INSTALLATION: (No septic t or s epage pit permitted"if public sewer is available within 200 feet,) k PACKAGE TREATMENT { ] []- Size____. Sq p / -X-�"------- ---------- Liquid Depth --- J�------------------ Capacit; ----------------- Type ------------- Material------------------'-- No. Compartments Distance to neare :yWell -----629----------- ----- p• ___Foundation __fes_______.. Prop. Line _ ___ __ -------- _ ' Length of each line_." ___-----______Notal Length __1 ___....__.._.__ T s D' Box Type FMlte °°Material _ ____Depth Filter Material ....I _ _ - Distance to.nearest: Well ___ "_:__"":----- Foundation --------------kProperty Line ................ SEEPAGE PIT Depth --Z-S7--------- Diameters_ "---- Number ---_--1Rock Filled YesNo 03 Water Table Depth --- -------------------------------- �� -------------------�•---Rock Size ---��-�--�---T�--•--- ��/'_/�-Z_____Foundation '�_1�__._______ Pro Line . _�________ Distance�to nearest: WeII�,��E�____-.__ p. REPAIR/ADDITION(Prev. Sanitation Permit r# _��-��j_________________________ Date __________._______________________) Septic Tank (Specify Requirements)a� `} ------ ---..-- ----------------------------------------------------- ------------------------------- --------------------------- Disposal Field (Specify Requirements) .eel----�.m-� .�� v fes- -� � - ' (Draw existing and required additiori on reverse side) i 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 Distr)ct. Home owner or licen- sed agents signature certifies the followingc'� qct "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 beta ! bject to ar a compensation fgwslof California. t Signed . { - . --..-._:-- ' , O,Wn BY ---------- -------------------- Title, _------- - (f other than owner) j s FOR DEPARTMENT USE ONLY t APPLICATION ACCEPTED BY _.__1____.___ .---- ---�------------------------------------------------------------ -------------- DATE ------- =-5--Tom'------'- 1 BUILDING PERMIT ISSUED --- -'-! ------------DATE -------------• -'__-- _---- ADDITIONAL COMMENTS 1_2jll.ix�_/3f_�__, �te. ec�__y_-_: _�'�'_ ! '/t.oT _ '.� --- ------------------ ---------- . = -- ---- --' - ----------- ----------------------- r '------------ ---- --- ----------------------------- 1 �,�.N., f- > = Final Inspection by --------------------------------- ' =' Date s SAN JOAQUIN LOCAL HEALTH DISTRICT E: H..9 1-'68 Rev. 5M