73-455 - Laserfiche WebLink

Home Browse Search

r FOR OFFICE USE: APPLICATION��OR SANITATION PERMIT --------------------------------------------------------- _ (Complete in Triplicate) Permit No: -----------_--------_------------------------------------ This Permit Expires 1 Year From Date Issued Date Issued 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 - nd existing Rules and Regulations: JOB ADDRESS/LOCATION .__ � --;L - ��. al�c '� � E SS TRACT Owner's Name l l ------------------------------------------------------- ------ Phone - ----- --------------- Address _._ 7v0 ✓�---Rf - -__. Cit ' y r.�.rs�'i / , --- --- -- --Me -------�------------------ - ----------------- Contractor's Name ___. _ ��, --------License # C3 Phone ' _ o Installation will serve: Residence ❑Apartment House❑ Commercial :❑Trailer Court ',❑ Motel F] Other _ �� __f .M Number of living units:.___._____ N�mber of bedrooms ____________Garbage Grinder ------------ Lot Size ______________ ------------------------------ Water Supply: Public System and name --------------------------------•-- ---------------------------------------------------------- ---------------Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt[] Clay ❑ Peat❑ Sandy Loam -❑ Clay Loam :❑ Hardpan ❑ Adobe 9, Fill Material ------------ If yes,type ---------------------------- (Plot -_- ______________ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No. septictankor seepage pit permitted if public sewer is available within 200 feet,] i PACKAGE TREATMENT ( I SEPTIC TANK f ] Size------------------------------------------------ Liquid Depth -------------------------- Capacity I------------------- Type -------------------- Material------------- -------- No. Compartments V Distance to nearest. Well ____________________________________Foundation _________ Prop. Line ...._...___�_....._ \ LEACHING LINE [ ] No. of Lines ---I____.___________ Length �Ac_ ch line______ �_r_.____ Total Length __/0.0_____________ t r� t l WA I' T`d`1 b' Box __ Type Filter Material __.Depth Filter Material _______- - ____________ Distance to nearest: Well Foundation ---Z_Q------------ Property Line -------------- SEEPAGE PIT [ ] Depth __ ___- Diameter __ ____ Number .--------/ ---- ---_____ Rock Filled Yes o 7 Water Table Depth f 0-f -------Rock Size _t X-/k Distance to nearest: Well ________________________________________Foundation -------------------- Prop. Line ---•---•-------•------ j I REPAIR/ADDITION(Prev. Sanitation Permit# ________ ------------------------------------ Date __________________________________) 1 ,.r SepticTank {Specify Requirements) ------------------------------------------------------------ ------------ --------------------- ---- ---------------------------- - f' F ff _ � ��r/ Disposal Field (Specify Requirements) -- -- -- --- -- ---------- -lQ -------------------------------------- - ----- - -----------------_-_------- 41, =- � -- - --------------------------------------------- ---- ---------------- ------------------------ I (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. Home owner or licen sed agents signature certifies the following: "I certify that in a erformance of the work for which this permit is issued, I shalt not employ any person in such manner as to become bj to W rk an's-C mpe tion laws of California." Signed -------- w - � "' Owner „ BY - --------- - -- - itle ------------- (If other than owner) FOR .DEPARTMEN SE ONLY APPLICATION ACCEPTED BY ---- l"- ------------ DATE --- �-- •--------- ' BUILDING PERMIT ISSUED ----------/I ---- ---DATE ------------------------------- ADDITIONALCOMMNTS ------------------------------------------ ------------------------------------------------------------------------ .. - ---------------- a -- -- ------------------------------------------------------------------------------------------------------------------------ -------- ---- - - - ----- ----- --- ------- ---- - --- --------- Final Inspection by: ---_ Date ----- - -- - JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Re . M