73-1116 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT- - -----=--------------- Permit No. .73--_��--- (Complete in Triplicate) "" ---------- ------ ------------------------------------- —1)--73 _----__-_------------------ This Permit Expires 1 Year From Date Issued " Date issued ly-_-- -------- 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. 549 and existing Rules and Regulations. JOB ADDRESS/LOCATION _._ ------ .___-______ Get Ail, l?! D- ------- ----- --------CENSUS TRACT --•----------- ------- Owner's Name -- ----------0-4-t- ..........IPA eA—if4--------- -------------`--------- -----------------------------Phone Address ------------�41/_6_ = -jiE �91_C� .------P--------- . City Contractor's Name -------A, �----------------------------------------------License # Phone Installation will serve: Residence [A Apartment House°❑ Commercial Trailer Court_,❑ _ - Motel ❑Other -------------------------------------------- I 4 , Number of living units:_.____-__ Number of bedrooms ____________Garbage Grinder --- --__ tot Size ..-____ __,� ______________ .__ Water Supply: Public System and name �_-__ - pP Y Y ------------------------------------------------------ ------------------------------------ -•-------• Private Character of soil to a depth of:3 feet: : Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ,❑ Clay Loam5a Hardpan 0 , Adobe ❑ Fill Material ------------ If yes, type ---------------------------- (PI'ot plan, showing size of lot, locatiori 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,) 11 �• ' ' /f SEPTIC TANKSize t PACKAGE TREATMENT ------ ------ Liquid Depth ----- ---- capacity -•-Ca acit Type Material---------------------- No. Compartments --- ---------- Distance --------- Di nce . ---- , to y ! nearest: Well __ _,____ — _-._..Foundat,ion _-145_ _________ Prop. Line ............. � LEACHING LINE No, of Lines`' _ _ Len thof each dine...... -1� / Total Length _ 'D' Box ------- _-_ Type Filter Material Al&_,V�UDepth Filter Material:__/�_________________________________ Distance to nearesf-7well _=-�1-_._J_--...__._Eouridation ------------------------ Property Line ------------------------ - SEEPAGE PIT [ ] Depth Water �__---------------- Diameter ---------_ . -.-------------------------- .Rock Filled ' Yes' C] No C] Water Table'Depth ------------------------------------------------Rock-Size------------------------------- v. Distance/tomnearest: Well _______________________________________Foundation ------------------7-Prop._Line _-_____---1,_____-___-- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date _---___________________-_______. 3 Septic Tank (Specify Requirements) --------------------------- ---------------------------------- ---------------•-----------------------••-------•----------------------------- Disposal Field (Specify Requirements) ----------->- -------------------------------------------------------------------------------------------------------- -----------------•--- ---------------------------------- " - --------------------------------- --------------------------------------------- ------------- Xik- ----------- -=-��(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 Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Homeowner 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 Work an's Co tionnsalaws of California." ham: Signed - -- ------------------wc: ,i-� ------ -----••------------- Owner By ' ' - --------=-- Title ------ ---------------- --------------------------------------=-------- (If other than owner) I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - -------- --------- -------------------------------------------- DATE ------------------------------------------- B-01.1-DING PERMIT ISSUED_-- ------------' ----------------------------------------- ------------------ ----------- --------------DATE --------------------------_-----.-------- ADDITIONAL COMMENTS -------------------------------------------------------------------------- - - ------------------------------------------------=----------•--------=------- ---- ----- ------------ ---- --- -- - - - �` = �` - -- ______________________________________________ _______._i_._-_-______-___.______-_.-_-__________________'S_______.-_'-------- -- -_y_,_1-i _ _ _ ---____ __ _ --__.------_-_-_-- Final Inspection by: --------------. - ------------------------------------------=--------------- - - -4--=' Date _.-ft '-D�- 3 q SAN JOAQUIN _LOCAL_HEALTH T,RICT ' E. H. 9 1-'68 Rev. 5M