75-248 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: l� APPLICATION FOR SANITATION PERMIT Permit No. ---------------- -------- '-------------------------------------------- 'Complete in Triplicate} 7S' -------- ---------------- ------�-- - This Permit Expires 1 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 madeiin compliance wi h County Ordinance No. 549 and existing Rules and Regulations: -I --- -- � - -- - ----- --------CENSUS TRACT -------------------------- JOB ADDRESS/LOCATION ----�-,--I ------- -�= - ---�--- �--`�-{- ------- - - -- Owner's Name _lZ.- /C l)e 56 emi --------------------------------- ------------------•-------------------Ph e --------------------------- -------- !VAI ------- -5 ----- --------------- -------------------- Cit o !`+ I� -- --- --------------- Address • City l o�7104-- .� Contractor's Name -�-d- �i4 / t1I�+ !!rl/41Ricense # ------------------------ Phone --------------------- ------- Installation will serve: Residence ❑; thr pc}ft hent House ❑ Commercial .❑Trailer Court °❑ Motel /Oe Number of living units: ge---' _-__ Number of bedrooms ------------GarbaGrinder ------------ Lot Size _ _ Priv Water Supply: Public System and name ---------------------- -- --------------------------------------------- ----------------- - __-J ' 1r! :�k I-* w, N x- Peat Sand Loam Clay Loam ❑ Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ ❑ Y ❑ ' lHardan Adobe Fill'Material __"--__--- if Yes, type ---------------- pan (Plot plan, showing size' of lot, location of system in ir6lation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if„pyblic sewer is available within 200 feet] PACKAGE TREATMENT [ ] SEPTIC TANK:[ ] �xia 41� Size_?f�U-"”-t -f---�'��`L Liquid Depth ------------------- -sJ q` Ca acit ��- T e Mafierial_ ;n No. Compartments p y 1 YP I Distance- to nearest: Well __ -Y--------------------------•Foundation --- - ---------- Prop. Line ---- =•---•- 41, LEACHING LINE [ ], No. of Lines --- ------------------ Length of each line---_--- ----- Total Length _-- -d---------------- C 'D' Box ____._____.- Type Filter Material �c_(�- Depth Filter Materia __-"----= -- y I r >r { Distance.to.nearest: Wel l.__��-�---- Foundation Property Line. G SEEPAGE PIT [ ] Depth ---- --------------- Diameter a_________------- Number ---------------------------- Rock Filled Yes ❑ No �' WaterTable Depth ----- ---------------------------------.---------Rock Size -------------------------------- ' Distance to nearest: Well -------------------------------------- �Foiindation ------ Prop. Line ---- ------ -----•-- 1t� t.a-" Date --- REPAIR/ADDITION{Prey. Sanitation Permit# ------- r. Septic Tank (Specify Requirements) -------------- ----- ° (,{ � . -Me------------------------ Disposal Field ( pecify equirements) -•---- S Cad-- }-- i _ _ _ ------------------ --------------------------- w - ------------- -------- --------------------------------- --------- -------------------------- (Draw ------------------ ------ ----------------------------------- - --------------------------------- prep i _ . .� (Draw existing and required addition on reverse;si a •-----�--� r I hereby certif that I have re ared this application and that the work will;§e, done in accordance with Sand Joaquin County Ordinances, State Laws, and Rules and Regulations of the. San Joaquin.Local Health District. Rome owner or licen- sed agents signature certifies the following: terson in such manner "I certify that in the performance of the work for which this permit is issued, I shall not employany p, as to becom?e subject to Workman's Compensation laws of California."w � Signed -- -------------------- Owner i e --------------- F I By ....��7444y- __0 __ Title _-- %y1A ----------- Y = ------------- other than owners k E. OR DEPARTMENT USE ONLY L .. a APPLICATION ACCEPTED BY -- -- _-- t " : ° - -------------- DATE �- BUILDING. PERMIT ISSUED ----------------- -------.---- DATE _.._ =--------------------- BUILDING. ' ' ADDITIONALCOMMENTS ---------------------------------------------------------------------- F ____"___________"____-____- 9 ________________________ ____________ __._"_________________________________________________'_-___--- n �_. ______________ - __________ Final Inspection by: ��-- 7-� --- ---- -------- ---------------------- ---------------------------------------- SAN JOAOUIN LOCAL HEALTH DISTRICT r E_ H_ 9 1-'68 Rev. 5M