75-341 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT "00 ................ ..• Permit No, (Complete in Tripticatel ..�,?... ..._.. ._ s ,�/ter " ...... ............. :............................•_........._....._-.._.-.... This Permit Expires 1 Year From nate 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 � 173J p / ............ . .R.�fi.�'G..--/_�--...�'Q ._.._......._....._..CENSu5 .RAC!' ..................... Owner's Nome ............ �..... ... .... .. .. ......... ........Phone ..................... Address .. . --•--• City ........................ r... . .. f - - f ,'' '• Contractor's Nome ....... /<....................License #1Z7M_7. Phone Installation will serve: Residence Apartment House C] Commercial ❑Trailer Court 0 Motel ❑Other ......... `Number of living units..../------ Number of bedrooms ____ --_-Garbage Grinder /�iC?.. Lot Size . e. Water Supply: Public System and name ------------------------------------------------------ ....... == ::. = .Privatec� : .'Character of soll to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loom ❑ Clay Loam ❑ t ' Hardpan ❑ Adobe R Fill Material .......... If yes.type ----------------- --------- (Plot plan, showing size of lot, location ofsystem in relation to wells, buildings, etc. must be placed on reverse side.} c NEW INSTALLATION: {No septic tank or seepage pit permitted If public sewer is available within 200 feet,} I PACKAGE TREATMENT [ ] SEPTIC TANK f ] Size------------------------------------------------ Liquid Depth ......................... Capacity __3................ Type Material-----..-__...._..----- No. Compartments E Distance to nearest: Well ....................................Foundation ...................,....Prop.'Line ............. . LEACHING LINE �:- [ j No. of Lines ------------------ --- Length of each line---------------------------- Total Lengthr ....._....................._. t 'D' Box ..--#------ Type Filter Material ...... ..........Depth Filter Material ....__.._.........................._......3 Distance to'nearest: Well ................ Foundation ....................... Property",Line-•.--_._.:::�...... ..._.� SEEPAGE PIT [ } Depth -----t.=...._.._.<::.._Diameter--,_............Number --- .--- Rock Filled Yes [] No Q� Water Table Depth .........................__..................Rock Size ................................ = A EDistance to"nearest: Well ----------------------------------------Foundation ......_-_._......... Prop. Line--.•--.•.---..•----- i } E� I, REPAIR/ADDITION{Prev. Sanitation Permit# ............................................ Date .............................. • o Septic Tank (Specify Requirements) -------------------------- --------------------- ---------- ................................................. ..................... iDisposal Field (Specify Requirements) ..........s ...LL' -1 ' .... ,� ,� /jl�/..----- --•- fn :....__:.. '-------------------------------•--------_ -----'l_T __ `: ;r ................................... ........................ - '*� , ' (Draw existing and required addition on reverse side) + j I hereby certifj that I have prepared this application and that the work will tae done in.aciardance with San Joaquin County Ordinances, St6te Laws, and Rules and Regulations of the San Joaquin.Local Health District. Home owner or licew sed agents signature certifies the following:_-___�.r.rr, "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 .............._-------- .--- --Kne .... Owner i s ......---• Title tC�'��,�C�_-•---.....: l By ............................. ... ........ . ......._. (If other the J - • s FOR DEPARTMENT U E ONLY oe APPLICATION ACCEPTED BY ----- ---- - ---------- - ---- BUILDING PERMIT ISSUED ..........................I........__-- -- - ...................... __ - ---• .......... .. ...- ... .:.........DATE ........................................... ADDITIONAL COMMENTS .............................................. _._.,..... ---••---------------------------------•--------•--......-----------------------...---•----.-_-•-•---------------------------- :.. ------. .._... ......................... Final Inspection by: ---:"__--- Dates SAN JO LOCAL HEALTH DISTRICT 71_ E. H. 1-'68 Rev. 5M w 7177 3 H