75-720 - Laserfiche WebLink

Home Browse Search

-r5-•-E FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. 7`S.-��--• - ............ .......................................... 1Cornoetein Triplicate) ................... Date Issued This Permit Expires 1 Year From 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/LOCA ON ............ ..CENSUS TRACT .......... •-- . .- i pQ/ R.-- _ PhT;�.................... Owner's Name . 2. -- City ....... Address ..- --..�. ....:.. -1.-•'-..�-; ��.`� ... .-...-- - �•� .. /�. ...---•-•............... [ .. - .f., /i :... . �l z�..License # a �. Phone (� ` Contractor's Name .................... I Installation will serve: Residence ❑ Apartment House 0 Commercial ❑Trailer Court .❑ 'k Motel 0Other _ar?`. .--- P-N,-- - Number of living units:.........:.- Number of bedrooms ----........Garbage Grinder tot Size .... - ..e...._..... Private Water Supply: Public System and name .........................---.------- --- Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay, ❑- Peat: Sand._.Loam, Clay-Loom-[Qi. - -:�....s...� - . Hardpan E] Adobe Fill Material ----.. if yes, type ................ lPlot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.l NEW INSTALLATION: (No septic'-tank or seepage pit permitted if public sewer is available within 200 feet,) 71 1I . Liquid Depth ..------_------ .......� PACKAGE TREATMENT [ ] SEPTIC TANK[ a q p Material........ No. Compartments , Capacity - �---._ ...... Type ................... ------_--------••-- Distance to nearest: Well . .... . ........... ...Foundation Prop. Line .- D Length of each line. ... .....--- ...--. Total Length ------------------ ------- LEACHING LINE [ ] No. of Lines . ... . .... .... 9 'D' Box .;.° . Type Filter Material _..-----------------Depth Filter Material ..------ Distance to nearest-. Well ..........-------------- Foundation Property Line --------------------- ------ Diameter ..... _. Rock Filled Yes (:1De Depth No SEEPAGE PIT { ] p ^� - -•-•-----•- �"-- Number . .. .......__- — Water Table Depth -. ----- ---Rock Size ..---------------------------- , } Distance to nearest: Well .................... Foundation Prop. Line ------------------ I -----. Date -------------•- REPAIR/ADDITION{Prey. Sanitation Permit# .... ) ....... .. . .....- - ....... ----- 'i Septic Tank ISpecifY Requirement! j Disposal Field (Specify Requirements) t -a 41<- ,..�...F- ^: -— - �. .�:...------------------------------------------------------ --- ......... .... ....... - -------- ---- --- .. --- -- --- (Drdw existing and required addition on reverse side) hat the work will be ne in accordace h Son Joaquin I hereby certify that I have prepared Rules and'cation and Regulati Regulations the San Joaquin LocalHealthD st ctnt Home ori licen- sed Ordinal s, State Laws, sed agents sig re Certifies th Bowing: "1 certify that i the orrh nce f the work for which this permit is issued, I shall not employ any person in such manner as to becom su j �tt o W m 's Compensation laws of California." Signed _ .......... .... . . ... - .- ...... --•---I-�•-- � - �-.......-... Owner By (1 other than owner) FOR DEPARTMENT USE ONLY _ APPLICATION ACCEPTED BY • -:)i:----• . .. ........... ..... . .. ,:...... .... .......- DATE _... . ................................. DATE . _..........................-----•.--•••-. BUILDINGPERMIT ISSUED .-- :...---------..--------------------------------------- -..-.------------------- -- ----- .------............. ADDITIONAL COMMENTS .---.....E .. - ................................•- -------------------............ •.----. .......... ••---- .... ----• ----•----•----- -------- ..... ---------..--_-- ..-.... ....... ....... ------------ ----.... If. ........ -----------------•-----•---------•--....---...--- ---..:..--- •---- --- - ---- --------- � ---- -Date ....�/��5.-................---•- - Final Inspection by: .......•..........'-;,•------- - ' SAN JOAQUI L At HEALTH TR �,; 7172324 -