74-1022 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT a 11� :._...:.......... ............. ..-------------... Permit No. ..��`..•-- (Complete in Triplicate) '................._._..._.....---...._.I.._......_.I--- //-x`73/ I .................... ................ This Permit Expires t Year From Date Issued Date issued Application is hereby made to the Son Joaquin Local Health District for a permit to construct and install the work herein 1 described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ...................CENSUS TRACT .......................... ' }f!! ._. .... _ .: � -C - - Phone . . r Owners Name _7 � •.............•-- _ }..... Address �1.9j.. ... �Irr1. __ V.. CityfC`? ia/ .. .;�� :. Contractor's Name -------.License # ' i f ::::. Phone Installation will serve: Residence [A Apartment House C] Commercial ❑Trailer Court Motel ❑Other ---------------= . ., Number of living units:.--"...----. Number of bedrooms .........Garbage Grinder ............ Lot Size,--------------------------............. , Water Supply: Public System and name ........-------------------------------.......,._......---------- Private.-•----.........------.............-------..... ❑ �. -�€ Character of soil to a depth of 3 feet: Sand T] Silt❑ Clay' ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ V Hardpan ❑ Adobe-❑ Fill Material __.......... If yes,type .......................... �.1 (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic.tonk orseepage pit permitted if public sewer is available within 200 feet,), PACKAGE TREATMENT ( I SEPTIC TANKi ] Size.......•........................................ Liquid Depth ................ .._...... __.-- No. Compartments ...:..._:_. Capacity .................... Type ----••---••--------- Material---------....__._ .: .... � Distance to nearest: Well ... ..Foundation ....:_§ ;prop7l.lne ..................... t LEACHING LINE [ ] No. of Lines _.. �t�:�------..-_-. Length of each line._ a.-- `_ Total Length ................I........... D' 'Box __ Type F+Iter Ma ial � Depth Filter—Material. :............::':.......--------..:--•------ Distance to nearest: Well P.__._,..-_ )Foundation .t ' _ . _. Property Line � .�._...... ,rLA SEEPAGE PIT [ 7 Depth ..�-- ------------ D'►ameter Number .........off-f.......... Rock Filled- Yes (A •-� No ❑ r • Water Table Depth ............................... . ............Rock Size ......:.......----------•-... f Distance to nearest: Wel} --/.A.D..-ET.---...... ..____.Foundation ---&A...--___._. Prop,•.Line._�,�..............:. REPAIR/ADDITION(Prev. Sanitation Permit!# ---------------..........------•---••---..-- ate ............_.____._............. ) Septic Tank (Specify Requirements) ................... ...................... .........................................................r----•--•--•-- Disposal Fiel (Specify Requirements) .,-- _.»_....._._ ...................................................................____......._ ------_ _....-- ......................_ . .......................I---------(Draw existing and required addition - ..---•.......------. ...... a n on reverse side) _ ff" t hereby certify that I have prepared this application and that the work will be dons in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of, the San Joaquin Local Health District. Homo owner or licen- sed agents signature certifies the following: "I certify that in the performancq of the work for which this permit is issued, 1 shall not employ any person In such manner as to became subject to Workman's Compensation laws of California." , Signed R. rs ',� Owner - ...... .. r .....----•--... x i ......--•............. ..... Title ................................................................ (If other than owner} FOR DEPARTMENT USE ONLY i' APPLICATION ACCEPTED BY ..__...._ DATE ..................... ...... BUILDING PERMIT ISSUED .................................................................I...............-.........:..............DATE ............. r ADDITIONALCOMMENTS ................................... .............,............................=...........-__-_ --..-----....... ........... ........................ { ..............................................................•-.......-----•-------•----•-------._.............. ----------------.-------------- ----- Final Inspection by: _-•-• Date -�� zl' ?.4� --•-•-•••. ---...... .... ---•--•--••................... ..................................... SAN JOAQUIN LOCAL HEALTH DISTRICT e u 13 24 1_-,ca De.. PUA 7/72 3 M ,