73-763 - Laserfiche WebLink

Home Browse Search

ti- .. FOR OFFICk. USE: APPLICATION FOR SANITATION PERMIT ��-- 79-3 ----------------------------------------------- Permit No. {Complete in Triplicate} - ---------------------------------------------------------- -73 ------------------------------------ This Permit Expires I Year From Date 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. 549 and existing Rules and Regulations: ^� ii �/J / CENSUS TRACT ------------ ---- JOB ADDRESS/LOCATION ._�1__Cc�_ _ ,___!-".(-4NL�C>LZ ------------------------ Owner's Name C.-- 1 A/C 1 fil7� ---t------------------------------- ------_Phon6f_.F/4_."7 _7� �l'4 - 1.f1- � _ .f Address sd11 �� Y/ ------ ---- /v G Cit /f t�i'Qk5 - Contractor's Name . <- ------- - `P -----------------------------------License e---- Phone X65 Jf� Installation will serve: , Residence Apartment House❑ Commercial ❑Trailer Court i❑ Motel ❑Other -------------------------------------------- Number of living units:------------f Number of bedrooms ____________Garbage Grinder ------------ Lot Size � L �-._____________________ Water Supply: Public System and name'-_:_ s-- - ----------••- ----------------------------------------------------------------------Private [ Character of soil to a depth of 3 feet: SandJAt Silt❑ Clay ❑ rPeat❑ Sandy Loam ❑ Clay Loam (] Hardpan ❑ i 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 seepa� pit permitted if public sewer is available within 200 feet,) L A L PACKAGE TREATMENT ( ] SEPTIC TANK Size__ -7 _c ' 1 -------------- Liquid Depth -_ ------------- Capacity -----RPO- Type /-'Material ��_ �'1 -- - No. Compartments ------------•---••---- 6` istance to nearest: Well ------ � _ _______________Foundation ___1_v_f______ Prop. Line _��_ LEACHING LINE No' of Lines __.___-__- --------- Length of each line__ _''-/-��____ Total Lengthfr 'D' Box ____________ Type Filter Material _)_3_0_Cr---,Depth Filter Material _____ --_�__________________________________ Distance to nearest: Well)_ - -- __ Number ____________________________ Rock F d Yes No_ __ Foundation ________________________ Proper Line ------------------------ j_ \ 7 SEEPAGE PIT J Depth _____ Diameterr --___-'__� ❑ 0 Water Table Depth Rock Size y Distance to nearest: Well -------------------- -------------------Foundation ------ P p. Line ---------.---------.-- io REPAIRJADDITION(Prev. Sanitation Permit# -------------------------- ----------------- Date ---------------------------------_} Septic Tank (Specify Requirements) ---------------------- -- -----`-- ----------K------------•----- Disposal Field (Specify Requirements) ------------- #'fel_ --------------�_!__---."72---------"'_-- `�------T----- ___-- ----- ------------------------------------------------------------- ------ - - - - - ---------------------ti l n -------------------_---------------------------- (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: "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 - --- -- -- -- -- ---- ----- �iQ/ Title . -- - ---- -- ---------------------- - ------------------------------------------------ (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BYt_ --0.--------------------------------------------------------- -------------- DATE ^. ------- BUILDING PERMIT ISSUED ----------------------------- ----------------------------------------------------------------------DATE ------------------------------------------- ADDITIONAL COMMENTS ----------------------------------------------------------------- - ---------- -------------------------- - ---- --- ------- ------- ---- -- ------------------------------------------------------------------------------------------ ----------- ----------------- --------- ------------------- - ------------------- ------------------------------------------------------------- -------------------- ------------- ---- --- ---- Final Inspection �',------- --- ------ --------------- ------------ Date '- - - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M