73-399 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERM Permit No: . .73..r`3•�� (Complete in Triplicate) Date Issued This Permit Expires 1 Year From Date Inued ! 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 mode in compliance with County Ordinance No. 549 and existing Rules and Regulations: I;7/J7 4-� ....-----. .....CENSl15 TRAC7 JOB ADDRESS/LOCATION ...... .-.. . Owner's Name ..:_...._ ...............................•---._..... ....-----------.Picone . 1 -.7�� �J.ani.-----•--�'�.S�E."------------------------ - Address City f3 _ . ---------------•----...._......••...•------- --------- ---------- -------------------------------•----------- Contractor's Name -. .--•��.- 1.11� J�,---•---------------•----..._..-'.---..._---- License # - - - Phonec;Z3�--/,.J --- �.1 Installation will serve: Residence Apartment House 0 Commercial ❑Trailer Court ❑ Motel ❑Other -------------------------------------------- Number -------------- - - --Number of living units:.. ._._.. Number of bedrooms _.....Garbage Grinder ------------ Lot Size . A, C---------------- Water Supply: Public System and name ------------------------------- ------------ --------------------------------------- ---------------•Private ❑ �. Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay C) Peat C1 Sandy Loam El Clay Loam Hardpan ❑ Adobe ❑ 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 available within 200 feet,) + PACKAGE TREATMENT [ ] SEPTIC TANK ] p Size............._........•----------------------. Liquid Depth .......................... /j��J.. ....-• Type t�'�s��-�9- Sl-. Material_ ' No. Compartments ---fl� � --••-- q Capacity ._ ._ _ y � . Distance to nearest: Well _. ��1_-_--• ................. -. 0.............. Prop. Line --- --•------ -• LEACHING LINE [ ] No. of Lines ---- - --- -------------- Length of each line----- -. .. Total Length 9 -----.------------------••-- 'D' Box Type Filter Material /VA�� .Depth Filter Material ....,,1 --...... Distance to o arest- Well ../e'`--------------- Foundation 114................. Property Line SEEPAGE PI`F [ Depth .3.....__.._..__- Diameter _ Xl� _l'Jum er;: -:� .�.r .r _ . -..•.Rock_F.illed_Yes No [j Water Table Depth -------------------------- ----------------------Rock,�Size ....... ...-tom- .... ` ,.� Distance to nearest: Well ..........:...... . -----_-Foundation ...._.. ...:_ _'. Prop. Linb .>.--------•---------- k REPAIR/ADDITION{Prev. Sanitation Permit# _ Date ........... ........ - --- t "�' Septic Tank (specify Requirements) ----------------------------------------------------------- � .............. Disposal .'Field (Specify Requirements) i f t.f... .......... -------------- •--------------••-------------------- ............... -----------•---•--------_._-- (Drow 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 San Joaquin Local Health District. Home owner or titan- sed agents signature certifies the following. t ' "17certify that in the perforrnonce of the work for which this permit Is issued, i shall not employ any person in such manner t as to become subjec to Workmag ompensation laws f California." ' Signed .:........... �f.. ---- YitleX By ---- t (if other than owner) j FOR 1 l R DEPARTME T USE ONL �- �; ........ DATE ....s1` Y7-`_.1: . APPLICATION ACCEPTED BY -----•------ --------------- ---------- ....... ------ BUILDING PERMIT k ISSUED -------- .. ._•----- .. --•---- -- -•-- -- -- : - - _--DATE .. ..:............:..... ... i ADDITIONAL COMMENTS --- ------------------- ---------- ! ' O• ._•_______________________•--____-___-.:-___--___.--_-__--._--____-__.....-_..._.-__....__-___._._-..:•^•.__._-.. - -----------------• _•---•-------_ __••_•'_--•__- --_-_•-_i--__-----_--•__ • _-_• _.. -....__-• - ......-._.. __-..--_ : Date Final Inspection by ' ---- ------ --•-- .._ ................ t �.... ' .._ SAN JOAQUIN LOCAL HEALT TRICT_ k 7.172 3 A 1 � 7 •tea n_.. eaa