73-662 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: I � �, APPLICATION FOR SANITATION PERMIT 73-�C ?— 51 ,OS............._...s:... (Complete in Triplicate) Permit No. ..................... This Permit Expires f 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/LOCATIO �g� ?E <2r� c CENSUS TRACT .._..... ........ Owner's Name , f�tc ----_.�.c.? r. s.---•-•............... -- ............ ...................... �j --------........-- Address .... '-- C�s�Gc�l�-t ._..: ...... City ��r-r��......:.............................................. Contractor's Name .......S�? -- ---------------• ..........................License # -.__-................... Installation will serve: Residence ❑Apartment House❑ Commercial ❑Trailer Court 5 r Motel ❑Other .........:..... Number of living units:..._!--.---- Number 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 .- � ❑ y ❑ Peat❑ 5andy Loam ❑ Clay Loam ❑ i Hardpan [] Adobe--0 Fill Material ------------ ifes Y type (Plot plan, showing size of lot, location ofsystem in relation to wells, buildings,.etc. must be placed on reverse side.) NEW INSTALLATION: t i _ (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) , PACKAGE TREATMENT [ ] SEPTIC TAMC f q-�-' Size.. .PX4.1_r < ! -- ------------------------- Liquid Depth +......... 00 Capacity I;Zo ----__- Type ��✓L-.. Material.... c- No. Compartments tante to nearest: Well .. .... ..Foundation _... g --•....... .........,�.�--.. Prop. Line NG LINE [ No. of Lines ...-- -------- ------- Length of a ch line.._ __._._... Total Length l m ------ LEACHING ....I .a..... h D' Box _ !�_.._ Type Filter Material . ..__. - -Depth Filter Material .__ .-_•_,��r_ l -•-•----••.....--•-••... Distance to nearest: Well ...c.5`d.r........... Foundation ........... Property line ........................a i PIT [ � Depth =---_-•-+• 6 SEEPAGE ., ---------- Diameter- ------------=--- Number ---------------------------- Rock Filled Yes [] No ❑� Water Fable Depth ............................ Rock Size 10 1 Distance to nearest: Well ...................•__. •_.-.....Foundation 7 --....._ •-----.....-•---•--. Prop. Line REPAIR/ADDITION{Prey. Sanitation Permit�# .................. ----- Dote -.-,.............................. I Septic Tank (Specify Requirements) ........................................... i .. . -- ........-•.............................•-......._....... Disposal Field (Specify Requirements) .............. -.............------------------...__... ------------••----------•--- ------------------------------------------------........................ ....................................... .................... (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 Saes Joaquin County Ordinances, State Laws, and'Rules eguiations of the San Joaquin Local Health District. Home owner or licen- sed agents signature 'f[es the fol[owin . "I certify that in th pe or nc of h work f r which this permit is issued, I shall not employ any person in such manner as to become su ect o rk n' pens ion laws of Owner California.,, Signed - ..__ . -... r By ............... .....................-----------I........... ................ •-•••---•-- ............. Title ...._.._....... ......... (If other than owner) t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY............ .+ .,�✓ , ...... --•--------- .._ . DATE .......... . 23........ BUILDING PERMIT 155UED --------------- --•• -- •.....................�----........---............_. --------------DATE ...........-............. ADDITIONAL COMMENTS ....._._...••---- . .. + ........................ ••----.......................................... -----------------------I.................._.:._._ .. r Final Inspection by= .......--•---- -----------------------------------------•- -------•Date SAN JOAQUIN LOCAL HEALTH_DISTRICT