72-764 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION F OR SANITATION PERMIT --------------------- ------ ------• -------------------- A, . -' Permit No: (Complete in Triplicate) --------------------------------------------------------- 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 and existing Rules and Regulations: JOB ADDRESS/LOCATION .Z_9 �, e Q�_�L�,u_�SZ +� ----- -----------------------CENSUS TRACT 1.t5'-`� ------- Owner's Name --7 �_�-�-�.�'----�-�---�-�--AT�-L ------ --- ------ ----- --------------•---- --------------Phone �--- , Address Z s' -C�© - Cit --------------- Contractor's Name ---=---------:------- ----------------------------------------License # ------------------------ Phone s ---------------------- Installation will serve: ResidenceX Apartment House ❑ Commercial ❑Trailer Court ❑ i Motel ❑Other -------------------------------------------- Number of living units.-__1___.__ Number of bedrooms ___--___Garbage Grinder .-� Lot Size ____e?1__1_' _________________ Water Supply: Public System and name _ �'_t'J _ ------------------ -----------------------------------------------------------!----Private ❑ a Character of soil to a depth`of 3 feet: -Sando Silt❑ Clay„ . _Peat_❑ Sandy Loam;,❑ Clay Loam ❑ Hardpan E] Adobe E] Fill Material ------------ If yes;type ._ _- �jA (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc, m st�be-plac4 on reverse side.) ' - NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) W PACKAGE TREATMENT { ] SEPTIC TANK I ] Size----------------------------------------------1- Liquid Depth ----._____________-_,____- Capacity ------------------- Type --------------i---- Material---------------------- No. Compartments ------•--__ - Distance to nearest: Well ____________________________________Foundation Prop. Line _______________7--__-- LEACHING LINE [ ] No, of Lines ____ ------------------- Length of each line---- ---- Total Length ___--__--______-_-__ { Type -------------- -----Depth Filter Material --------------------------------------- Distance ----------__ i 'D' Box -------_-_-- T e Filter Material _ --------------------------r--•- Distance to nearest: Well _______________________ Foundation Property Line _____-______-__-__-_--__ SEEPAGE PIT { ] Depth ___________________ Diameter '--------------- Number ---------------------------- Rock Filled Yes ❑ No Water Table Depth ------------------------------Rock Size----- -------------------------- Distance to nearest: Wel! ----------------------------------------Foundation ____________________ Prop. Line --------------._._---_ i REPAIR/ADDITION{Prev. Sanitation Permit# _______ q-Al�____________._.__ Date __________________________________) Septic Tank (Specify Requirements) --------------------------------------------- --------------------------------------------- ------------------------------- Disposal --••--Disposal Field (Specify Requirements) --11.Q----------- __F '------�f'-------------- �q- ------- /�✓- ----------- ----------- - >----------rte f T "( ,----------J�Xf _- '- ---------------------------------------------------------- --------------------------------------- --------------------------------------------------------------------- (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 as to beta a subject t Workm n's Compensation laws of California." Signed __ -fit -----------07`Zf Owner By -------------- ------------------------------------ --------------------------------------------------- -Title ---------------- - ------------------------- ---------- (If other than owner) FOR DEPARTMENT T USE ONLY APPLICATION ACCEPTED BY ------- '� DATE �� f BUILDING PERMIT ISSUED --------------- DATE -------------.----------------------------- ADDITIONAL COMMENTS ----------- --- --------------------------------- ----------------- ------------------ -- ---- --- ---------- -------------------------------------------------------------------------------'---------- ----------------------------------' ------- ------------------------------------------------------------ --------------- ---------------- -------------------------------- - Inspects _-___Date __ Zl --------------- FinalI -. _ _SAN JOAQUIN LOCAL HEALTH DISTRICT J/43 _ 7' ' E. H. 9 1-'68 Rev. 5M