72-319 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APP �� a APPLICATION FOR SANITATION PERMIT fib_ ---------------- (Complete in Triplicate) Permit ______________ This Permit Expires 1 Year,From Date Issued Date Issued 3'�` �� 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 incompliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION _.25550--Hitaa.y CENSUS TRACT Owner's Name --- ---------------.--::.----------------------------------------------------------------------Phone 8x83•-. a Address ---PYO-, °-Bax---ib6---- -------------=------------------------------------------------- City ---Fa.-rmi>`r ----------------------------- Contractor's Nam, BlaCkard'_S_ S_eptlC__Tank• Li ense # ____2 $951-.__ Phone __4631-7-0-4a_...___ € - ------------------------ Installation will serve: Residence ❑ Apartment House-[:] Commercial,®Trailer Court ;❑ i 'Motel ❑ Other ---------------- r .' Number of living units:-_--____._. Number of bedrooms ------------Garbage Grinder ------6- --Lot Size 22-5!X---60-1--------------------- Water Supply: Public System and name -----------C:Qmuhia ___________________Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe [T Fill Material ._____-.-.-- If yes, type ____-_--_________________ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) k NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK[ ] Size------------------------------------.------------ Liquid Depth _______________________ 1 Capacity `` Material______________ 0 ' i P Y ------------ ------ Type -� _'------- ---- No. Compartments ---------------------- Distance to nearest: Well ------------------------------__-_-Foundation ---------------------- Prop. Line ---:__---_..____.____- LEACHING LINE �] No. of Lines -------I----------_----- Length of each line-_____y�_f______------ Total Length _---_40_0------ --------- tt 1 'D' Box ----,ti_J--- Type Filter Material _2----------------Depth Filter Material __-,.9!'----- _____.._______..__........... ' Distance to ne'-arest:.,Well __. --------------------Foundation -------- Property Line ---- -..------- I ; SEEPAGE PIT Depth ------2-5.t------- Diameter ___4,8„_____ Number -----1-------__------------ Rock Filled Yes)E] No Water Table Depth ------90 ------------------------------------Rock Size --------2u-------------------- Distance -- ------ - -Distance to nearest: Well --------NCMe-------------------- Z_e_."_ Pr Line __.,JF _Foundation ______ _ Qp. , REPAIR/ADDITION(Prev. Sanitation Permit# -•------------------------------------ --- Date --,-----------------------------_-) SepticTank (Specify Requirements) ---------------------------------------------------------------------------------- ----------------------------••------------------------ i Disposal Field (Specify Requirements) ----------------------'��e--Leach Line_&--------------------------- ------48 ! ------------X25 C-deep ...Pit -- F ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------" -------- ----------------------- ------------------------------------------------------- (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 the performance of the work for which this permit is issued, I shall not employ any person in such manner 1 as to become subject to Workman's Compensation laws of California." Signed ------- ------------------------------ - --- ---- Owner -------- ------------- - - - By -- -------- --- - --------------- ------------------ ----------- - (If other than owner) FOR DEPARTMENT USE ONLY t APPLICATION ACCEPTED BY----=----------- --- ----------- - - DATE __.._` �_--7?'� BUILDING PERMIT'ISSUED --DATE ------- ------- --- --- ------------ NAL COMMENTS ------------------------- ------- --------------------------------------------------------------------------------- ------------------------------- ------------------------ ------------------------------------------------ ----- -- - ---- ------- -- --------------- -- ------- --- ------ - ----------- ------------:---- Final Inspection by: --- - _ --------------- - -Date _ °/__�-�__2_ - AN JOAQUIN LOCAL HEALTH DIS ICT E, H. 9 1-'68 Rev. 5M