73-488 - Laserfiche WebLink

Home Browse Search

4 FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT v Permit No: ------ -_- --------- r (Complete in Triplicate) �, f ----------------- --- ----------------------- --------- � p � Date Issued �.'-�--- ---1-,• , This Permit Expires 1 Year From Date Issued ------------------: rict he work Application is hereby made to the San Joaquic at with Counealth DtytOrdinarna permit and ex sting Rulestalndt Regulat ons{e�n described. This application is made in compliance -----------------------CENSUS TRACT --------------------------- JOB ADDRESS/LOCATION --JZ_ - dS .... ��M Phone Owner's Name -------- -- -- --- --•-----• City J�.� .z'k --- -----� ------ -------------- ------------------- Address ---------YAM r� --------- ------"------- ------------ ------ ------ ------- --- Phone License # _--------. - Contractor's Name _-- ---- -� --- ------- -----"-- ------ - -- - --- - Installation will serve: Re sidence)g0partment House�Q Commercial ❑Trailer Court :0 Motel ❑Other - --------------------= ,.,.,& trti.. �!. .. ---- Number of living units: �_Pk&umber of bedrooms -�4_._...Garbdge Grinder ------------ 0 --"-------- Lot Size private E-1 � Ir�--�- -- .--__ •----------- Water Supply: Public System an name ------------------------------ ClayLoam:❑ Character of soil to a depth of 3 feet: San Silt fl Clay ❑ Peat❑ Sandy Loam E] Hardpan E] Adobe ❑ Fill Material ------------ If yes,type ------ (Plot Ian, showing size of lot, location of system in relation-to: wells,-buildings, etc. must be placed on reverse side.} ; ` ( p '- �t ermined if public sewer is available within 200 feet,]. -= NEW INSTALLATION:`. -(No septic tank or seepage p' p �r, i e--------------------------------- ------ Liquid Depth [ i �; I PACKAGE TREATMENT SEPTIC TANK'[ ] 60571-W' /` �� --.Material-- --------- No• Compartments " l Capacity ------ ------- -- Type ------------- Distance {to nearest: Well ------------------------------------Foundation --------------------- Prop. Line --------------- 0 Total Length ------•------------•-------- LEACHING LINE [ ] No. of Lines �1 Length of eacl_line-..-----=------- �'` De th Filter Material --------------------------- ---------------- r 'D' Box ._---------- Type Fit r Material ----------- = = p Line I Distance to nearest: Well ."--------------- Foundation s---------- Property -- ] SEEPAGE PIT [ ] Depth Diameter ^-Nmbe; -=-------------------------- Rock Filled Yes ❑ No Q -----Rock Size ---------------------------- - ` Water Table Depth -------------------------- ` " . - 1 ' Foundation -------------------- Prop. Line - .... Distance to nearest: Weil ------_ : ti. -------------- Date --------- ---------- -----•------1 ecif Requirements) =: = v a .. R ADDITION(Pr . Sanitation Pe,m�t ,�� - ----------------------- -- ------ ------ " i Sep p Y � .: at t7 X---- ± ,vim Disposal Field (Specify, Requirements) -----`7>, ` " � .�— i ' ta ' ------- --;--- ------------r --------------- ---------------- - - ---"- - (Draw existing and required addition on reverse side) r .� i hereby certify that I have pre aced this application and that the work will be done in accordance with San Joaquin Y County Ordinances, State Laws;and Rules and Regulations of the, an Joaquin Local Health District:�.Home owner or icen- sed agents signature certifies the following: person in such manner "I certify that in the performance of the work for which this permit is issued, I shall not employ any p as to bec su ' rkm�n's Co ensati I sof California." f Owner Signed .�- ------------ Title _..... (If other than ow ier) OR DEPARTMENT USE ONLY .-.,. DATE _..�------ APPLICATION ACCEPTED BY -_.. ----- ---- --- - -- -------------------------------- ------------------ ----------x----- ----- --- -A"-"--- -- --- -------- -•----- -------DATE ... ---� ------- ------------� ----------- BUILDING PERMIT ISSUED ------=----- --------------- ----- ------ - ------ =----- ------ --------- ADDITIONAL COMMENTSG z -------------------- L �H_" r�- - --- --------------- ---------------- . ------ � ----- ------------------------------ R --- ----- ----- ate -- -- -- - - �f. " D _ --------------------------------------- - ------ Final Inspection by: ---- ----- -- - ----------- -------------- -- SA JOAQUIN LOCAL HEALTH DISTRICT u o 1-'66 Rev. 5M _L�j