72-399 - Laserfiche WebLink

Home Browse Search

�, s✓d ;72- FOR OFFICE USE: ?,APPLICATIONI�;.SANITATION PERMIT ------------------ e Permit . � Z , a [Complete in Triplicate) -�------�--- -------- --------------- Date Issued --------------------------------- --------------- This Permit Expires 1 Year From Date Issued I Application is hereby made to the San Joaquin Local Health District for a per 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/LOCA I N ------ 2 ---- -- --- ----LLv �j�l A----/'�P' ------------------------ ---- --CENSUS TRACT -------------- ------ �-� _Phone Owner's Name ---- --- -!R!`g_�iFY_---- --1�--��-�---- ---------------------------------�---------------=-•------------- - - --�--�-••-•------ �,t Address ---------- -------------------------------- City f ec fCr -------- ------,- r Contractor's Name ------------------ ---- -------------------------------------------.License # -------_---------------- Phone ------------------------------ Installation will serve-. Residence [?Apartment House-[] Commercial [-]Trailer Court ;E] Motel ❑ Other -------------------------------------------- Number ___._Number of living units:----- Number of bedrooms ________Garbage Grinder Iv --- Lot Size .__.--_--_..l_ _______- 1 Water Supply: Public System and name --------------------------------------------------------------------------------------------------------------Private,] fi � N Character of soil to a depth of 3 feet: Sand❑ Silt ElClay ElPeat E] Sandy Loam ❑ Clay Loam ❑ l Hardpan ❑ Adobe.X 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 tank or seepage pit permitted if public sewer is available within 200 feet,) ► PACKAGE TREATMENT ] SEPTIC TANK ] Size------------------------------------------------ Liquid Depth --------------�---------- IL 17 i Capacity 1 Type ------------------- Material No.� Comparnm nts 1 'Distance �.to nearest: Well -----------,�____________-_____Foundation ----J_/-------------- Prop.-Line ------�:......... LEACHING LINT [�Q i No. of Lines ---------= ------- - g �S` S' 9 - _ Length of each line__.. _7___y 1_ _-__ Total Len th ______._Z ____ ___. D' Box ---------- Type Filter Material --------------------Depth FilterMaterial --------------------- ---------------- -_- k IDistancelto. nearest: Well ____1S____________ Foundation .____33_________ Property!Line ___35__--_- i a /YDepth . �2—_______ Diameter __ _____ Number _____________ _ Rock Filled Yes � No .t❑ SEEPAGE PIT ;�} b�;: # . .�"~ � aWatbr.-Table Depth ------------------------------------------- ----Rock Size ' Distance to nearest: Well ____________________________----_____--.Foundation .____ --------- Prop. Line -------------- REPAIR/ADD! } 1 I TION(Preva. Sanitation Permit# -------------------------------------------- Date ---------------------------- Septic Tank (Specify Requirements) ----------------- -- ----------------------------------------------------------- ------------------------ --- ------ µ� 4 _ q _ Dis osal Field- S ecifY Re uireme is = - -----'F- ------- --------------------------------------------------------------------------------------------------- I? y ----------------- 9 =(Draw existing and required addition on reverse side) !E I hereby certify that l� have prepared this application and that the work will be done in accordance with San Joaquin County Ordinphcei,'Sl'ate'Laws;and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following:,h.----�_—_ "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." x Signed --------------------------------------------" . -------------------- t- --`----------------- Owner r„ w _ J—(If other`than•dwner)i' FOR DEPARTMENT USE ONLY i { APPLICATION ACCEPTED BY --0 - --- ------------ DATE ----_--.---' BUILDING PERMIT ISSUED A TE /Ko_ -- rADDITIONAL COM t_P �,7 - -�- r - - ----- ------------- - -f - � ---------- . � ------ --------- ----------------------------------------------------- ---- ----------------t :Frnar�n�sp etion by: ---------- -- --------- ------------------------------------------------------------------------------------Dae Jam" JOAQUIN LOCAL HEALTH DISTRICT "` E. H. 9 1-'68 Rev. 5M ' ,