71-912 - Laserfiche WebLink

Home Browse Search

' FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT permit No. ---------------- ---- ---------------------- --_- (Complete in Triplicate) :_, ------------ ------------------- ------- Date Issued --- # This Permit Expires I Year From Date Issued ` Application is hereby made to tf�e San 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 ._ _ C ' -�-_o �- ---_. - ----�--- - �-�-�-��---�- --- -------`----��--- CENSUS TRACT =-'-`�-..-- �?'! ------ ,`5�✓ '�' :- ---- -Phone - -------------------------- Owner's Name ---- '/�� ---------- r- I Address _ I 4. y QllJ--------------- -----. City r�f�d Al--------------------------------------------------- ------- ------------------ - -- •---- -- /� c32 Contractor's Name --- - 1- ---� � � ---- #� ---- Phone .�--- � -- - /'�--- ---------------- - -- License Installation will serve: Residence (NJ Apartment House❑ Commercial: Trailer Court ❑ k ' Motel ❑Other ---------------------------------------- s Number of living units:..-.-/----- Number of bedrooms -.3------Garbage Grinder ------------ Lot Size Aft-w-e-1-------------------- Water Supply: Public System and name -------------- --------------Private Character of soil to a depth of 3 feet: Sand'F Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay loam ❑ 1 Hardpan ❑ Adobe -E] Fill Material ----------- If yes, type ---------------------------- (Plat, plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) 1 septic� seep a it permitted if public sewer is available within 200 feet,) if G tank or ACKAGEATR TREATMENT NT [No SEP�IC TANK' Siz - -X-V-----��- 7-------- --------- Liquid Depth -.ZJ__i_�--------,----- y --Q-00---- TYP Materialv` N0. Compartments --- Capacit'y' -^^�-- - �'\1 Distance to nearest: Well ---s? ---- Foundation ---------- Prop. Line __ ________________ ----- Len _ Total LEACHING LINE [�No. of Lines �- - __-_-_--- Length of each.line Length -------- _-__.�_-__-- 'D' Box ------------ Type Filter Material - ____Depth Filter Material ---/ -------------------------------•-- i �e to nearest: Well ----- ;1--------- Foundation -_�-�--------------- Property Line, -_-Q-----_-_--__-_--- SEEPAGE PIT [ ] Depth R -_--__ Rock Filled Yes No Distance Diameter ---- Number - ❑ Q WaterTable Depth ------------------------------------------------Rock Size ------------------- ----------- fl Distance to nearest: Well -------------------------------------•--Foundation ------------------ -- Prop. Line .................. -- r 1 f REPAIR/ADDITION(Prev. Sanitation Permit#,-------•---------------- ---------------- Date -----------------------•-------- SepticTank (Specify Requirements) -------------``----------------------------------------------------------------.---I---------------------------•11--- ------------------: Disposal Field (Specify Requirements) ---_�,, -----=-- �� Q-- Al t -------- ' ,SvmnVT_------. i_S_ �iV - hDt�071_40-r\l------49� ` I -J1. ----------- .fQ--'---------------------------------------- } ']Drawexisting 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 f 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 ~ - --j --- -- ------------------- 3 Owner By -------- `---------- Title ----------- -n. -- (l# other than owntter) „ 1 FOR DEPARTMENT USE.:ONLY'� A PPLICATION ACCEPTED BY -': _ - -_. - ---. DATE ----------- --- - - -----_-_--- -------------- - BUILDING PERMIT ISSUED ----- - --------- -- � -------------------- DATE --= ADDITIONALCOMMENTS - -------- -- - ------------------------ ----- --------- ._ :-- ------------------ --------------------- --------------- --------------------------- # ----- - -------------------------- ------------------------ ----------- ------ --------- - ------------- ------------------------------------- - --------------- -------- -------------- ----------------------- ------ -- ------ --------- ------ -- ------- - - - - -- - - - ---- - - Final inspection , -------•------------ Date s Z------`- P -j-_ -- SAN JOAQUI:N-LOCAL, HEALTH DISTRICT E. H.'9 1•'68 Rev. 5M -