72-363 - Laserfiche WebLink

Home Browse Search

IN FOR OFFICE USE: APPLICATION FOR SANITATION 'PERMIT '7 ---------------------------------- ----------------------- Permit No. (Complete in Triplicate) _•-----..-,-...---------- ----- -------------------------- Date Issued 7 ---------:--------------- This Permit Expires I Year From Date Issued -------------------------------- Application is hereby made to the San aquin Local Health District for a permit to construct and install the work hirbin described, This application is made in compliance with/County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION--------- CENSUS TRACT -------------------------- 7------------------------------- --------- `� Name ---- -- e----------------------------------------------------------------------------------------Phone ------------------ ------ Owner ----- -------:---------- City 41:9 ---- -------------------- --------- ---------- --------.License Contractor's.Name ---44-2-J5! 0' 4-vQ ale--- --------------------------- - #Py3wF-1... Phone -_.9...... Installation will servo: ;-Residence p4Apartment House,[] Commercial -E]Trailer Court ;E_] r."I' -.Motel Other -----------------------------------•-------- 'bedrooms -..__...._..Garbage Grinder__._.- Lot Size Number of living units:...... Nu'�nber,of- ----------- Water Supply: Public System and ri I -------------------------------------------------------------------------------------------------------------Private Character of soil to a depth of 3 feet: Sand' Silt 0 Clay ❑ Peat❑ Sandy Loam ❑ Clay,Loam ❑ Hardpan ❑ Adobe-0 Fill Material ------------ If yes,type --------- ------------- (Plot plan, showing size of 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 availablewithin200 feet,) PACKAGE TREATMENT SEPTIC TANK Size----------------------------------------------- Liquid Depth ---------------------.-----i "� -- Capacity ------------------------- Capacity ---------- Type --------- ---------- Material------- r------------ No. Compartments --------------- Distance to nearest: Well ------- -----------------------------Fou dation --------- ------------ Prop. Line ---------------------- I, I I LEACHING LINE No. of L166s ------------------------ L ngth of,each line---- ----------------------- Total Length ------------------- ........ 'D' Box y ---------- --------- ----------------------- T pe Filter terial -------------------- pth Filter Material ----------- Distance to nearest: Well --- ------------------- Founda ton :------------------------- Property Line Type Filter L_-_-n e g r 'e'r n- 'a e0- u- pth nda ton _n, Depth ---- _ __ 'm -------- SEEPAGE PIT -------------- Diame er ----------------- Num erN--------- ------------------ Rock Filled Yes 0 No 0 0 r Water Table Depth --------- --------------------------=---- -----Rock Size -------------------------------- 4 ov IDistance' 0 nearest: Well -------------------------------- ------Foundation --------•.--- Prop. Line ---------------------- mi 1%1� I '%,. F S6nitatioi�l Permit ----------------------------------- bate ------------------------------------ REPAIR/ADDITION(Prev SepticTank (Specify Requirements) -------------------------- ---------------------------------------------------- ----------------------------------------------------- Disposal Field (Specify Requirements) ---------------------------------------------------------------------------------------------------,---------------------------------- J ------- ----------------------------- ---------- ------------------------------------------------------------------I------------------I------------------ - --------------------------------- ------------------ ------------------------- (D raw 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 Son Joaquin County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local Health' District. Home owner or liven- sed agents signature certifies the iollowinj-.' "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 -------------- ------ - ---------------------------------I--------- Owner By ------- --------------------------------------- -Title --------------------------- -- ------------------------------------ --------------- (If other than wner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---- --- ------------------- ------------------ DATE -----c�:7� ------------ ---- ---------------- BUILDING PERMIT ISSUED -----------------------------------------------------------------------------L-------------- -----------------DATE -------------- ----------------------------- ADDITIONALCOMMENTS ---------------F---------------------------------------------------------------------------------------------7-----------------------m------------7-------------- --------------------------------------------------7 ---------------------------I----------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------ ------------------- -- ----------------------------------------------------- --------------------------------------------- -------------------------- --- -------- Final Inspection by Date .0-t�� ---------------- ---------- ------------L-------------------------------- ------- -------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M