73-25 - Laserfiche WebLink

Home Browse Search

OFFICE USE: APPLICATION FOR SANITATION RORMIL �3 ----- r r � Permit No. ------------ (Complete in Triplicate) -- — __ y . ------ -------------- -------------- ;! - - - -- x: Date Issued �:�°-�---3 This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein ip described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: ------ - Owner's Name ------"yG---- 10/- - p Phone(__ , _' _ . _ ------ Address �.�o----- - ------------- ---- �` 'I City 6- -66 p � =-------License'#�-wQ��L-------- Phone � --------- - -- ... Contractor's Name - 1� Installation will serve: Residence ❑ Apartment H-ouse❑ Commercial ❑Trailer Court l❑ Motel ❑ OtherryLL�JVCs-.---1- ' -� Number of living units_____________ Number of bedrooms ___Garbage Grinder ------------ Lot Size ___-__.___-___________--__-____-___...___ Water Supply: Public System and name ------------------- -------------------------------------------------------------------Private ❑ "`� Characterr of soil to a de hof 3 feet' 'Sa-nd Silt Cla 'P`eat Sand Loam Clay Loam❑ e^-� p ❑ ❑ y ❑ . � ❑ y ❑ Y- Hardpan ❑ Adobe I Fill MateriaF__j-.__:__ If yes,type ____-___.__________________ rr 11 (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 �Q 6 .Size.-__Q__ x--�-_------------------------- Liquid Depth ._-___.__-------.----.----- ?.,Oa6 _ / �_______ Material-4 No. Compartments -_Z___. .. CapacitY�----------�� Type --- ---- -- --------------- p --- Distance to nearest: Well ------------- ----------------------Foundation -------------- Prop. Line --------- LEACHING :------LEACHING LINE No. of Lines ___ 1_____________ Length of each line.__----�149 ------------ Total Length ------ R__..-------_-__ D' Box - Type Filter Material ____.--,-',Depth .'Filter Material _______l�------------------------------- :j._ # i � i Distance to nearest: Well _______________________ Foundation ----AP___._-------- Property Line ---�___._____-_--- SEEPAGE PIT Depth ----.� -�--- -- Diameter --------=r- w t + ' w--- Rock Filled Yes No i0 - Number _ __ .f- Water Table Depth ---------------------------------- ••---Rock Distance to nearest: Well --------------------------------------••-Foundation __f Q: __+.--- Prop. Line -s----- ------ REPAIR/ADDITION(Prev. Sanitation Permit# --------------------n----------=---- ------ Date ---------------------------------- - -------------------------- t 1. Septic Tank (Specify Requirements) -----'------------ - ------------- -------- ---------------------------------- ------------------- ------------- Disposal Field (Specify Requirements) ------- -------------------------------- ------------- --------------- -------------- ------------------------ -------------------------- -- _ _____________- ----- _ ----------- - - _ sem• � - __________________________________________ - ----- ------------------------------------------------------ ___________________._____;.,____________.-________. ._____ (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 , -� Title ----- C-40 f---------------------------------------- -------------------------------------------- By ------- ------ -- (If of than owner) FOR DEPARTMENT USE ONLY --R3--�.� - APPLICATION ACCEPTED BY ------ - --- (� ------------------------------------ -------------- ----------- - DATE - - -�--- ------------ BUILDING PERMIT ISSUED ---------------------------------- - -------DATE -------------•----------------------------- ADDITIONALCOMMENTS --------------------------------------------------- --------------------------------- ------------------------------------------ ------------ -•-------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------- ----------- ----------- ------ ff - - _ ---------- ----- S� Final Inspection by: ------------ ---------------------------- Date SAN JOAQUIN 4-f:OCA HEALTH,DISTRICT" X C, . L u 0 1_'AQ U." J;" "