71-007 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT �y rPermit No. , ov------- (Complete in Triplicate) ------------------------------------- Date Issued ----------- --------- This Permit Expires 1 Year From Date Issued i 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 e xigg Rules; Regulations. r JOB ADDRESS/LOCATION ---------=--� 7 A - � TRACT /'! I c -------- ---------------------Phone�C"7.�""-.7"r7-�-------- Owner's Name ------------'�'.�-�-�'-----I`?..=----- �---�-�'_��.a-------- - Y I C�6k 7 Cit 57v a/c ro �r Address -- � Y -------- --------------------------------------------- ------- Contractor's Name U/�-�'�-- �-�-D-+s-fie- u t--��-°-�---------------------------------License # ;2 G.Y"7._v__o------ Phone Y-7f�_.7'_�`7._Y-.-- Installation will serve: Residence ❑ Apartment House[] Commercial ❑Trailer Court ',❑ Motel ❑Other -------------------------------------------- Number of living units:--.-- __- Number of bedrooms - ------Garbage Grinder .-__---__- Lot Size .r`' -/ -�----------- ---------------- Water Supply: Public System and name ------------ .... f f Private ❑ Character of soil to a depth of 3 feet: Sand'[ Silt❑ Clay ❑ Peat❑ Sandy Loom ❑ Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material ------------ If yes,type ------------------------- - s (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,} ____ PACKAGE TREATMENT ( ] SEPTIC TANK'[ ] Size___ "- :" ©_ LC mpa�ments L / pth Ca acit / --------- Type -- Mat , Distance to nearest: Well ""__ -----------------Foundation --./.d----"""_"__ Prop. Line ---S. ""_ r / -- LEACHING LINE j ] No. of Lines ---------- Length of each line.-- ~�"+-_--"-- ----- Total Length ;" -_""_"--------- ---- r 'D' Box ---- -V__ Type Filter Material Pkao� Depth Filter Material --/-9"" •--._r--------•- Qistance to nearest: Well - __""" -""_ Foundation "." `Q l"--"-"""- Property Line _5_- __-.-._ i SEEPAGE PIT Depth __ Diameter ---------------- Number -,------- ------------------- Rock Filled Yes ❑ No ❑ i WaterTable Depth ------------------ -------- -------------- -----Rock Size -------------------------------- Distance to nearest: Well ------------------ -----------------_Foundation -------------------- Prop. Line ---------------------.! 1 REPAIR/ADDITION{Prev. SanitationI. Permit# --------.----------------------------------- Date _""___""_.----"""_-- "-----------} Septic Tank (Specify RequiremenI s) -------------------'------------------------------------------------------------------------- ------------------•---------------------------- Disposal Field (Specify Requirements) ------------------ ------------------------------------------------ -- -------------- ----------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------- (Draw existing and required addition on reverse side) I hereby certify that 1 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 Ii:cen- 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 become subject to Workman's Compensation laws of California." Signe {"57 ��0 fir"57----- -•.��A-q-----�'-- C��''`s``` Owner �(,� Title - -------------------------------------------- BY ---- y ' ' GLI ---------------------- fother than owner) .DEPARTMENT USE ONLY �y/ APPLICATION ACCEPTED 'BY ----- -- - ----------------------------------------------------------- DATE ------�� ' f/ ----------- BUILDING PERMIT ISSUED - -- ---- -- ----------- ---- ----------° --DAT ----------------------------------------- - ADDITIONALCOMMENTS ---------------•-------------------------------------------- ---------------= F - ------------------------------------------------------------------------- i ------------------------'--�:------------------------------------------------- - ----------------------------- ` --------- ---------------------- - =_. - a Final Inspection by: ---------= ------------------ - ----= -- Date - - - -- ---------------------- i SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M