75-41 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT / ...... .. _ .�.--...��.-... ....2.'�_.7��.. Permit No. ...?:��__:.�_l. { {Complete in Triplicate} This Permit Expires t Year From Date Issued bate issued ..1..-. %r..7J� ................................................. 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/LOCATION ..3. 7-..•-- - •5 CENSUS TRACT ..............::.:........ �... �q i /� Q Owner's Namgqe .�.d-.. ..: ........... ............ :...._......... Phone. {p.r .._..p.. s: AddL_ .1._ .. City . ress . :........................................ Contractor's Name ..- -.. _. k -.-- , � r. Citense #0`�.7: J ..�. jphorie . ,. ... a Installation will serve: Re dente []Apartment House] Commercial ❑Trailer Court . r Motel C]Other - Numbe of living units------------- Number of bedrooms ............Garbage Grinddr ,. ------ Lot Size ...,--.-•_.-_----------------_-.--.......... Water�SuppIy-TP blit System and name ------ - -- ------------ -- �:... { ........... Private (Q _ .... . . Character„of.soll to a depth of 3 feet: Sand'] Silt❑ Clay ❑ Feat❑ 11,Sondy Loam ❑ - .Clay Loam ❑ p ❑ X Mate _.._ .... If yes,type ........................... Hardpan Adobe Fill Mat ._ � - (Plot plan, showing sife of lot, location of. system in relation to wells, buildings, etc. crust be placed on reverse side.) t � r } NEW INSTALLATI�ON: ,,INo septic tank or seepage pit. permitted if public sewer is available within200 feet,) i PACKAGE TREATMENT,[ ] SEPTIC TANK t ] Size................................................ Liquid Depth rpt t i. `�Cgpacity .. ....----- Type -------------------- Material...------....._-..- No. Compartments ...:..........a_...._ i Distance to nearest: Well /. � .. I p•. ----.. .............. 1 .--- �-�••... ...............Foundation .....�...---='=-� Pro line _ �" LEAC'�INGLINE [ ] No. of Lines ........................ Length of each line.----- ------------------ -.Total Length ........ D, Box Type Filter Material _._Depth Filter Mdteriai. Distance to nearest: Well ........................ Foundation ......................... :0operty Line SEEPAGE PIT` 1 7 Depth. ................... Diameter ................ Number ................ It..._. Ro k Filled Yes [] No I❑ rn 1 ' Water Table Depth Rock Size ............... .. I IV i Distance to nearest: Well .............................:....Foundation __._.i............. Prop. Line ......................11 i i r -__� 1 REPAIR/ADDITION(Prey. Sanitation Permit# ----_•.---•-t-•-.-•---•----------------•--• Date ._----._._............-.---------•) 5eptic.Tank (Specify Requirements) ............... ........... ....- ......._... ,......... �.... a �} �/ r Dispo al Field, {Specify Requirements) ... :vC__. ._........S-•--- �:.J.................... ................... ------•----- -------•....... ..................... ---------------•-• .. . --- ............ .......-................ (Drawexistingand 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 tha_ t in the performance of the work far which this permit is issued, 1 shall not employ any person in such manner as to bec " sub'ct to Workman's C r1pe o ' laws of California." Signed ..�'.�_ .... - -- ........ .......:........................... Owner By ............fes...'.................... ...................--.-...................1.....-------- - Title -�-��'_Ilf._otherthan�owner� �� FOR DEPARTMENT USE Y APPLICATION ACCEPTED BY .r _ .._ �r . .. DATE ....-.:. !__75...................... BUILDING PERMIT ISSUED -------------------- ................... . . ----.. ........ '....-•----...... -a`... . ....DATE ........................................... I ADDITIONAL COMMENTS ........:............................ ` ................................. ............................ ----------- --------------- ...-• --- ........... -•-- --. ..................... Final Inspection by: Date ... ........ . ---_. ....... ..... SAN J AQUIN LOCAL HEALTH DISTRICT r� 7/72 3 K