73-878 - Laserfiche WebLink

Home Browse Search

i 2 . -!I, I FOR OFFICE USE: APPLICATION- FOR SANITATION PERMIT 3 S�Sy --------------------------=------------------------ Permit No. (Complete in Triplicate) ----- ---------------------------------------------- This Permit Expires 1 Year From Date Issued Date Issued - � 7_N 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 -------- _ _ _ _ h�il .�_ �. � _--------_______CENSUS TRACT Owner's Name ----------- {�C? - Q � '-----------------------------=-=-------------------Phone Address ---------------- l - 7- ��_s /°1 City - af7- `v ---------------------••----•-•----•-- Contractor's Name --------- '� -------------------=-----------------------------=---- --License # ------ ---------- Phone --------------------------•-•- Installation will serve: Residence partment House❑ Commercial:❑Trailer Court I❑ k P Motel ❑ Other ------------ ------------------------------ E Number of living units:----�Nt mber of bedrooms ____ ______Garbage Grinder l ._ Lot Size ------- Water Supply: Public System and'name ---:------------------------------------------------------------------------------- ----------_---------------Private nr° . Character of soil to a depth of 3 feet: Sand'E] Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay-Loam . ?J Hardpan Adobe ❑ Fill Material ------------ If yes, type --------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings; must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,j PACKAGE TREATMENT E�TIC TANK' , Size - ---„--: --------------------- .�-:.---.---------'-� _ iLiquid Depth --------------------------� Capaci - - - ------- TYP ;- ------- � ial______________________ o. Compartments ------.----------:•_-- Distance fo nearest Well I � _ .Foundation __-- ... . ... . m ____-- ____ Prop. Line ........... LEACHING LINE [ ] No. of Lines __________ ____________ 'Length of each line------ Total Length -----------.___________-____ D' Box _.--------- Ty Filter Mate ial _'__________________Dep#h Filter aterial ---------------------- [ Distance to nearest: Well -------------------t_i_ Foundation --------------- _______ Property Line --_____ 7 SEEPAGE PIT ] Depth _._`�_______________ Diameter --------- Number ------------------- -------- Rock Filled Yes '❑ No Water Table Depth -----------------------------'-- Rock Size ----- -------------_-.----- S` ' (.i+ Distance to nearest: ell ------ --------------- ---------------____________--Foundation __ ----------------- Prop. Line ---------_----------- REPAIR/ADDITION(Prev. Sanitation Permit# --------------------------—-------------- Date ' _______________________________) Septic Tank (Specify Requirements) --------------(frmev ------- _�- �1- -_---- _ -------- ------ !R Disposal Field (Specify Requirements) --_L7_ -------2��Tll_c_ ------I—A -----------------Y( -1- - � . -- - � -� - 1nl. ---- -------GF..FP�?��------- --t? - -- _6 H ------------- 't�l 1 - 1.1�f QIL7 V� LsY i1, �5 --------- ---�----- ------ _ # (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:L0'ws,-and7Rule's and Regulations of the San Joaquin LocahHecilth District, Home owner or licem sed agents signature certifies the following: "I certify tin the per�F ante the orkifor which this permit is issued, Ishall not employ any Person in such manner + as to bet subject to ork n C nsati.on laws of fifornia. j Signed — --._ Owner BY ------------- ------------------------------------------------- �7 -------- �l i Title ----= ---- ----------------------=-------------------------------------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BYt_ - DATA -- -1-7-'^4--------- BUILDING PERMIT ISSUED ---- • --------------------------------DATE --------------- --------------- ----•- ADDITIONAL COMMENTS ------ ---------------------------------- -------------------------------- - ----------- ------- ------------- --- ------------ ---- --- --- - -- ----------- ---- ------ 01 - r -- _._. .�� v Final Inspe n by: -- _��_ ------- -- - --- ---------------------:-----------------------Date - ----- ,--.-..-- SAN JOAQUIN LOCAL HEALTHIVDISTRICT E. H. 9 1-'6$ Rev. 5M