75-250 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ,. APPLICATION FOR SANITATION PERMIT -------------------------------------- - �S—� s� (Complete in Triplicate) Permit N6 ..7 ....................... This Permit Expires 1 Year From Date Issued Data issued ..�..::��:.7� 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 jaunty Ordinance No. 549 and existing Rules and Regulations. 67 JOB ADDRESS/LOCATION .._. .o_�I•._.../ �,rY ...�'.E..__•__.....�.............................CENSUS TRACT ..............I........... Owner's Name .......... .......V ------. ._. ---------..:.....................Phone ---'�•-�9-�...��.�.�Z:. Address &.A.0.1?.......?1��......[i ye .q 4/ City pp�/ .. Contractor's Name — a a ..license # !6� `' �'... Phone 'Z.. ... . . . .......... .... . --........._...._.._._. .. Installation will serve: Residence [Z Apartment House 0 Commercial ❑Trailer Court 0 Motel ❑Other ............................................ Number of living units ..... Number of bedrooms ._j......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 j] Hardpan ❑ Adobe ❑ Fill Material ._._...__.._ If yes,type .......................... (Plot plan, showing size of lot, location ofsystem 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 [ ] Size................................................ Liquid Depth ..........................� Capacity ---...._.__---_.--- Type .................... Material--------.............. No. Compartments ..................... Distance to nearest: Well ....................................Foundation ...................... Prop. Line .................... 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 ............ SEEPAGE PIT [ ) Depth ____________________ Diameter ....... Number ............................ Rock Filled Yes ❑ No Water Table Depth .. .....Rock Size Distance to nearest: Well .................................. ..Foundation ........ Prop. Line REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- DateC--•_f_a......__T._'_.___.--S._____-.____- Se tic Tans (Specify Requirements) ...... ......................................................... ) "...�n Disposal Field (Specify Requirements) .-. � .. T..y 3 g � . .. . . . . s ----------• -•-•..................................................••-- --•--- -----------------------..._.........................................._........__......_............_...__.----•---------- � - - --' - -t--(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 e County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Horne owner or licen. -1 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 ........ 4A1.7'7 C!.�V1.....1 _4 ...........................---- Owner By -- • ..._../F�=E� : ..._ ..:._ -------------------------------------------- ;Title _..------........_..-. llf other erj z2FPMPARTMENT USE ONLY APPLICATION ACCEPTED BY ....__ ._ .. ._... ... ........................................................ ........................................................ DATE .............. /..... ......... BUILDING PERMIT ISSUED ........................ ._....__.... -------_............DATE ..... ..................................... ADDITIONALCOMMENTS ....----•-....-• --------------------------•-------.._.....----...----.........._..----------•--•----• ---------•............................................................. -------------------------------------------------------------............................................ ...........ice - ---------------------•------ ................ Final Inspection by: Date ........................ ............ .......---•............. SAN JOAQUIN LOCAL HEALTH DISTRICT E. H.1-3 241-'68 Rev. 5M 7/72 3 M