73-1109 - Laserfiche WebLink

Home Browse Search

FOR oF>+Icr" I,isE: - . APPLICAtION FOR.SANITATION PERMIT ................... Permit No.ALAVI (Complete in Triplicate) ......................................................... This Permit Expires t Year From bate Issued 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. 544 and existing Rules and Regulations: JOB ADDRESS/LOCATION ....��,�.,�.: ��(��'4---• 4G{ .._ . ... . ENSUs TRACT .......................... Owner's Name --- --------Wk-_. . .. .. •-----.� . .................. ..........Phone . / _ Address - ! ......... .._ - .. ,! .. City .............. Contractor's Name .- ,A-.- -Jr_ ., -Ncense # oh 2'!-L'`� Phone,— Installation will serve: Residence p Apartment House Commercial ❑Trailer G*ud 9.;r Motel ❑ Other ---------------............................. Number of living units:..-/-.- Number of §edrooms _......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 Clay Loam ❑" Hardpan [j 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 f � � � Siae_��.�-•---��.�...- --•------ Liquid Depth _..��...............•---• Capacity/ao.O_�X,4.Type �Mote►ial-- ---- ...-- No. Compartments ...,�-............ � r Distance to nearest: Well _ (l .Foundation ..... Prop. Line ..-3......_ ..... U1 LEACHING LINE No. of lines ---------------- Length of each line------1-0 �...._._._. Total length 'D' Box ... Type Filter Material .......Depth Filter Material ..- . .. ........................... Distance to nearest: Well/jw............. Foundation-.�................... Property Line Sf......._.........._.3 SEEPAGE PIT '' Depth c2:S�........ Diameter ,�__`..... Number ----.%................... Rock Filled Yes J No Q Water Table Depth ..... ___4�01--- Rock Size ....JZ....................... Distance to nearest: Well __..h C ......................Foundation/" ------------- Prop. Line ..'�i ............... REPAIR/ADDITION(Prev. Sanitation Permit# .........__................................. Date ..................................) SepticTank (Sp`ci Requirements) --------------------------------------------------- ........................................................................................ DisposalField (Specify Requirements) ----------••. .....-•------•--••....•--•---------•....................••. ................ ------------------------------------.. ..-----....-•---------------------- ------ -------------------------------------------------------------.......................................=-------•--..-._..----....- (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 laws, and Rules and Regulations of the San Joaquin Local health District. Home owner or licew sed agents signature certifies the following: "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 ........ ......... -•-._.. Owner BY ,h .. ............ Title ---- (if other than owners FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED i3Y .. ._. . . DATE ....1 -.1Q� - BUILDING PERMIT ISSUEDDATE .... •-----...............------------------------ :.............DATE ........................................... ADDITIONAL COMMENTS ...................................................•....---....---- ------------..................................•--•................................... ................................... -•................•_.._...... . - .. Final Inspection b ��...�-�� p y: .... ... . .. ...... --�••-----•-----------. -*... . ............-....•.Date ..... SAN JOAQUINj LOCAL HEALTH DISTRICT E. H. 1-3 24 11.'68 Rev. 5M 7/72 3 ,14