74-1064 - Laserfiche WebLink

Home Browse Search

FOR OFFICE LISE- APPLICATION FOR SANITATION PERMIT r......... ............................. Permit No. (Complete in Triplicate) ry ` ............. This Permit Expires 1 Year From Date Issued Date Issued .............. 'Health is 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 made in compliance with County Ordinance No. 544 and existing Rules and Regulations: JOB'ADDRESS/LOCATION`_R. ... -. . . -i - GtI�`. ..CENSUS`TRACT _..-.................. :.. Owner's Name ....... .- hone .................................... Address ..._...�gu�---..60 .... ----- -- --- t. City �.. ............. Contractor's Name .� tfil: t�f.�.-- -, r ..........:...kicense # �a..ATr�f.' ... Phoney Installation will serve: Residence ❑Apartment House❑ Commercial XTroiler Court ❑ Motel ❑ Other ........................._.----.._. ._.... Number of living units:............ Number of bedrooms ------------Garbage Grinder ............ Lot Size Water Supply: Public System and name ......... ..--Csi .._..__................................................Private ❑ Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat E] Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe ` Fill Material _.. ........ If yes,type ............................ Q (Piot 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 204 feet,( PACKAGE TREATMENT ( ] SEPTIC TANK Size./6.. X�- ft __/_.�..-. __... Liquid Depth .�� .�.........._.._._ { ` Capacity/ TypeMateridlNo. Compartments ...` - ......... .__.. Distance to nearest: Well ,.._Foundation �( ............... Prop. kine .._* ............ �.} LEACHING LINE No. of Lines ., _.. ..__. ..__ Length of each line .. 672�7.............. Total Len ,th Z1r-47_-Z......... 'D' Box Type Filter Material _..___Depth Filter Material :. !--------- ------ Distance to nearest: Well; �Z _L.c. _ wi oundatian_.. .............. Property Line ......... SEEPAGE PIT Depth _/ Diameter f_f_.. Number Rock Filled Yes Na - � 1T.. ar. Water Table Depth e... - - --=-------------------------hock Size --- -.-._.....- ............ _ Distance to nearest: Well --- re. .I `' ._---------Foundation �Q...�...... Prop. Line ............. REPAIR/ADDITION(Prev. Sanitation'Permit# _..----•.. ......... ------- D te ----------- ....:.-_------------1 yr Septic Tank (Specify Requirement) .......... t ----- L Disposal Field {specify Requirements)" _ ... :__ ".. `— "� ` ... i. ------------- ----------------- ---- --.... - ------ ----------------------------- ----.---------------------- -------------- --------------------------------. ..... ....... - 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 Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or [icon. 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 -:.. ..... . _..... - ------------- ..-.._ :�.._:z:-::y— Owner i By ._ �- Title . (if other than owner ` FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED DATE IL..Z-.r..-. _._.__._.. r...-. BUILDING PERMIT ISSUED --------- -----------.. ...... -•---...._... .......... . DATE ... _.._..---...-------•--•-._ ADDITIONAL COMMENTS ::. ... ........ .......... .... i T GIS i�l�S`�� ..... --------------------------- - -----............-------.._._.-------------- •-------..._.._.. Final Inspection by: --- Date .//.~ ".... . ........_------- SAN JOAQUIN. LOCAL HEALTH DISTRICT _ c u 13 24 1 •,.o n_ 9u 7/72 3 m