72-41 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -- -- - -- -- Permit No. (Complete in Triplicate) ---------=----------------------------------------------- This Permit Expires 1 Year From Date Issued Hate 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. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION --CENSUS TRACT _-_S4.7 7_ Owner's Name ----- .Ley- ------A1YC*7---------•---------------------------------------- -------------------PhoneA2__3_—j7/,;7_!7------ Address ---- ----"---•--- City A�clm_s_/_10------------------------------------------------- Contractor's Name __72_'-X 111-------------- ----------------------------------- --------License PhoneQ i Installation will serve: Residence ❑ Apartment House commercial []Trailer Court ;❑ Motel ❑ OtherA.�.E,�lku _ % • Number of living Number of bedrooms ~-------Garbage Grinder ________ Lot Size�_____f�'_.f�C/_�•�.��_____ , Water Supply: Public System and name -------------------------------------------------------------------------------------------------------------Private - Character of soil to a depth of 3 feet: Sand f[�ilt:❑ Clay ❑ Peat❑ Sandy Loam •C] Clay Loam ❑ ) Hardpan ❑ Adobe '❑ Fill Material_________.__ If yes, type ---------------------------- k (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,) 0.0 PACKAGE TREATMENT SEPTIC TANK ,-/ Size.11�� Q [ 7 [�'!` 7 � -X � ------- Liquid Depth I-------- --------- Capacity �6f ______ Type=7d4__ Materioa .400 ` Na. Compartments ................. i s S .. Distance to nearest: Well _._ _Q-------------------------- Foundation___-____- -__ Prop. Line .�__________________ LEACHING LINE [ o. of Lines _____ ---------- Length of each line__t9 __If____________ _____ Total length � Q. *+! __ - - --_--.--_-__ 'D' Box ,$___ Type Filter Material _ QCA-�-_._..Depth Filter Material Ig_ _________________________________ / __ Distance to nearest: Well -��_____________ Foundation'��______._________ Property Line -_ __________.._ SEEPAGE PIT [ ] Depth ---- ------ Diameter ________________ Number ---------------------------- Rock Filled Yes ❑ No i❑ Water Table Depth ------------------------------------------------Rock Size -------------------------------- Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ----...--------------- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------_-----) SepticTank (Specify Requirements) ------------------- ------------------------------------------------------------------------------- --------------------------- Disposal Field (Specify Requirements) ------------- --------------------------------------------------------------- ----------------------------------------------------:----------------------------------------------------------------------------------------------------------------------------------------------------- ------ - -�- - -- s ---------------- -- ------------------------------------------------------------- ------------------------------------------------------------ ------------- (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 licen- sed agents signature certifies the following: �r "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 ---- -- -�---�"--- - -- -�----------- ----------------------------------- Title��*�/✓.��_.��`,�.�f��✓- ------------------ - [I other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---------------------------------------------------------------------------. DATE --- - I3-- _ ----- BUILDING PERMIT ISSUED ------------------ --------------DATE ------------------------------------------- ------------------------------------------------------------------------- ADDITIONAL COMMENTS ------------------------------------ ------- ------------------------- -------------------------- --- - _ ---- - ------ = Final Inspe --- ---------------------------------Date .---- - . SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'6$ Rev. 5M