73-351 - Laserfiche WebLink

Home Browse Search

..r-----„-sem FOR OFFICE USE: APPLICATION FOR-SANITATION PERMIT ............... et '� Permit No. .��. � .. (Complete in Tfiplicate) A p .......................................................... Date issued ' This Permit Expd 1 Year From Date Issued ........... Application is hereby made to the Son 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: ,__..'Ll!,Q.R..__.....f..l._...X✓�.C+csrr� ;•i-.} •r�• ............... JOB ADDRESS/LOCATION' ....q�[d- --- (./. _;...� :_- _ _ ..� .��...-- CENSUS TRACT .# _ 1J?z .....:....... .. Phone ... _ U .. . _ --� Owner's Name `1`4" `-t ✓ �� 7�?d-fin ., •v�� ................................ Address ------•-•........ City ......._ ... I Contractor's Name . - - .........F•......License # . 6�.8'9fl?:/.. Phone Installation will serve: Residence ❑Apartment House❑ Commercial (]Trailer Court 0 MotelW Other --------_-------------•--.................... k � Number of living units------- -- Number of bedrooms __-__-----Garbage Grinder -----------. Lot Size ---.--- Y Private Water Supply: Public System and name -------••------- ---- ............. ......................I....... .........................._.._..........._ ( Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay ❑ E. Peat El Sandy Loam ❑ CI'ay Loam ❑ 4 + Hardpan ❑ Adobe(Q 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: (Na septic tank or seepage pit permitted if public sewer is available within 200 feet,) i t t Li PACKAGE,TREATMENT ( �• SEPTIC TAMC�t ] ,R Szze----------------------------------------•-• ---- Liquid Depth .......................... .....- 7 Cciacity -------------------- Typ l Material--- -- No. Compartments ................... ( " Distance to nearest: Well' ......_/......._ _...`.........Foundation _................ ....e Prop. Lin ...................... nes LEACHING LINE �(j- ,NO. of Lines --------.0,------- -- LengtK of each line-•--- (�-- Tot...-•----...: al ngth ::. -� I 'D'( Box . I.:._._ ....-• _... Type Filter Material . ` Depth Fitter Material 1 ..: ............' ...........--. Distance to nearest: Well .__ Z. 50_._...... Foundation ..__ ......_ .... Property Lind .. ................. i r-t EEPAGE PIT [ Depth .._....1��i.._ Diameter .._�tJ�- Number __.......-.a............. Rock Filled Yes No S Water Table Depth .._ Qd ! - Rock Size -----.... .. ......._. € --------- --- i Distance to nearest: Well__._... ` ...................Foundation -_.�4�..... Pro} . Line .----,1.�•-••----•• S t REPAIR/ADDITION(Prev. Sanitation Permit# -----.-•.......:................. pate --------- ........................ 'Septic Tank (Specify Requirements) ---------------•---. ---------- ......... 1.................................•-•••-----...-•-••-..........._._.....---1---� Disposal Field (Specify Requirements) ................... ��---.. --~ -� :.; ---!'�[ '••__X�_ ._.------_-•-. ' ....................•------------------------------------ .�,.�a,C •-------._... f i� (Draw existing and required addition on reverse side) ( I herby certifytthat 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 liter- sed agents signature certifies the following: �t i "I certify that in the performance'of the work for which this permit is issued, 1 shall not employ any parson in such manner I as'to become subject tc 1Notknsan's Compensafiori laws`of California." "�" 4 "s ( Si fined .. ........I........................ Owner ► Title ............... BY 31[/ " ....... . . ; (If other than owner) i FOR DEPARTMENT USE ONLY ' -7T APPLICATION.ACCEPTED BY _... �____. ..._ _ DATE . - L.... . . ......... DATE BUILDING PERMIT ISSUED .._.. ...:: :.:... _:. : ................. == -•-••--_...------•••... ADDITIONAL COMMENTS -...� �_., _ _ .. 7 ;v .................. . -• ............................................ •............... ...... .... __. 1, i rS ...................... .. _.�.p. .-.ti-_. ............. .f_ .......................... , v ^�•_-��.: ................ --- _....---•-•-_•-- i ..................... _.... Date .,Firiai Inspection b Wil ......•-•--..•........... ................r.............. , .. SAN JOAQUIN LOCAL. HEALTH DISTRICT 1 •tee n_.. epi ' 7/72 3.m