75-373 - Laserfiche WebLink

Home Browse Search

OR OFFICE U d a APPLICATION FOR SANITATION PERMIT ;...----•---------•-- «Permit-No. ---------........ (Complete in Triplicate) .......... ........:.. = ............. Y' t i Phis Permit Expires l Year From Dab Issued Date Issued . ... ...........JT Application is hereby made to the Sd n 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 ... U./✓JIrI.. ..-.._.. JYfj,!/s ....��j�.�.. .//,-XQ-A ..CENSIJS TRACT .................... ..... Owner's Name ....../—.,V'*',/ ........ ...................................:.........................Phone . ..--- City ................Address � � 1G/ Contractor's Name -�---- - ---------- -- ......._..:..............License # Phone ?�--.---. Installation will serve: Reside Q Apartment House{ Commercial ❑Trailer Court 0 S Motel ❑Other ........................................... .. .. Number of living un'i ..... ts:.. ......... Num .ber of bedrooms _ ..Garbage Grander Lot Size 1... ... ... .... Water Supply: Public System and name .....:................Private ❑ ...... -.... ._ .� - ---------------- Character of soil to a depth of 3 feet� Sand b Silt Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ r i. ',Hardpan ElAdobe 0'Fill Material ............ If yes,type............... ............ s (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 Size__._ _.x ./1 _ ............... Liquid Depth ....vim- :............ Capacity _ YPe - s � . Material..,x� .c.� No. Compartments ..., '............ , ........ ......�-..._.-_ Length of each line...... �n'-...1.Q......:... Prop. Line .. f a 4 Distance.to nearest: Well .: _� ______________ - LEACHING LINE [ } No. of Lines g � Foundation.` 9 J Total Length .... C?............... D' Box ...-G ._... Type Filter Material ._�,��' f�...Depih .Filter Material ..../ ................................ Distance to':nearest: Well . ... Foundation -..... ._.____._. Property Line ...�............... } SEEPAGE PIT [ } Depth ........ Diameter - ------- Number ....... . ... ....... ...... Rock Filled Yes 0 No i❑ 1 }I .Rock Size .. .- � Water Table Depth --------��......... ..................... /,�.: ....... A �i P Distance to:nearest: Well ___ �.t,(e ll...........Foundation ..-/Q.......... Prop. Line.../S..l............ f . s REnSSanitation iermit --•---------•---- -------. Date ................................... Septic pcify Rguiement ......L�!f.... ) ............................................. Disposal Field (Specify Requirements) __.-------------- -------------------------------------------------------------.....................................:.......--------- ------------------------------------------------- .... .. ri ------------------------------- .. .-.,-----------._...---------- ----------------------- ....... ....... ------------------------------------------ .................... ------------- --------------------'--�--------------------------------------------- --------------------------------............. --------...... ;(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 Orclinances; State Laws, and Rules and Regulations of the San Joaquin Local Health-DIshict. Home owner or liven. sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, l shall not employ any person in such manner as to become subject to Workman's i Compensation laws of California." Signed -. -- Owner By -- -- --- --------------------------- ------------------- Title _......------... -------------- (If other n owned R WARTAiNT USE ONLY APPLICATION ACCEPTED BY -- ----------- -- DATE,.:, BUILDING .PERMIT ISSUED .... . :....::.:.' •---•----------------................• ................ .......DATE ........................................... I ADDITIONALCOMMENTS ----------------------------------- --------------•--------------------•-•-• .......... ............................................................. -----------=-----------------------------:.... - -•---- ......... .............•---------------------- ....... ..-- - ...... < Final inspection by- ------ ------ ..------Date .. ...... . _ �l EH 13 2h 1-68 V. � ANSJOAQU LOCAL HEALTI! DISTRICT 8/7h 3M