75-830 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ................................._-....-....-.__..._- Permit No. ..7_..---...._.... (Com lete:in Triplicate) {y ........ ................. ........................... f. Date Issued .l-..."-....Y..... This Permit Expires 1 Year From Date Issued ......................I...................... ?-Y-7— Application Y-7Application 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: CENSUS TRACT ......... .. ... JOB ADDRESS/LOV :) .- / /�. ' Owner's Name - t-F." .._._ Phone . -'3 Gam.. f<. Address jyA{�� _ 'r............... .... . City ----....---..................._..- .. ---..-.._. Contractor's Name -- TU ...License �V.... Phone Installation will serve: Residence ❑ Apartment House E] Commercial Xroiler Court 0 Motel ❑Other Number of living units:............ Number of bedrooms ----------.-Garbage Grinder .... ....... Lot Size ........ Water Supply: Public System and name ------------------------ ............ .._-------------Private ❑- Character of soil to a depth of 3 feet. Sand, Silt❑ Clay ❑Peat❑ Sandy Loam Cloy Loam ❑ Hardpan `[� Adobe ❑ Fill Material ............ If yes,type .................... ...... N (Plot plan, showingsizeof lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,} u PACKAGE TREATMENT [ ) SEPTIC TANK t j Size-•-•-------------------------------------------- Liquid Depth ..._..._.........__.._...- Capacity -- . .---.. Type -------------------- Material.. ...... . .. .------- No. Compartments ..................... Distance to nearest: Well . ... .............................Foundation -- ........._....-. Prop. Line ..._-_.. --------- _. 0 LEACHING LINE ( ] No. of Lines Length of each line ........ ................. Total Length ....................--.----. 'D' Box - Type Filter Material --------------------Depth Filter Material .... --------------- _._-------•----_- - Distance to nearest: Well .............--------._ Foundation ..................... Property Line _....__...._.._.-_....... I SEEPAGE PIT [ } Depth _... Diameter ................ Number ....... ...._._._.I .._. Rock Filled Yes ❑ No Water Table Depth .......:................ •---- ----Rock Size _..------....................... -------------------Foundation ._._..._-. - ------. Prop. Line --_------------•- � Distance to nearest: Well _--------------------------------------- •'- r REPAIR/ADDITION(Prev. Sanitation i'ermit# ....... - ---------- .......... Date -- ) R I[ Septic Tank (Specify Requirements} .......... -------------.............------------------.._._.. __...--- ...................... ' Disposd Fie] (Speci R quit meets e; --��-��- ---(�'.•'�`�� -- �� -�- -- - ---'- - J k ......4 ag0 (Dr 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 Laws, and Rules and Regulations of the Son Joaquin Local Health District. Home owner or licen- se"gents signature certifies the following: "I ce" ify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner as to he�co b(e t to or an's mp nsation I of California." Signed .:<. ------------•--•------- ------ Owner Y - - - - Title . j_.. ................. I er than owner) FOR DEPARTMT � SE ONLY APPLICATION ACCEPTED BY DATE 7C .. .. . ................... BUILDING PERMIT ISSUED - ............. - ---•......... .. .. ..........DATE . .... ...... ADDITIONALCOMMENTS ............ ......... ... . -_ - ......-._.._...... ........__................ .._.................... -----------------------------------•---• - --.................... ........ _.............. ----•-------•.............•---..._....-....----- - .-------- --------------------------------------------- Final Ins ection b - Date ...Iv. �2 � Inspection Y. .....................- SAN JOAQUIN LOCAL HEALTH DISTRICT 7/72 3 M