76-223 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ............. �C-,)-,,),3 (Complete in Triplicate) r Permit No. 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/LOCATIONn..� .lir_. ,---C ........ .......CENSUS TRACT %................. Owner's Name ..G�/<.15.4../ x $ .......................................--.................................Phone Address ��i!' ce. ........City Contractor's Nome _ - ~ �� _. Phone installation will serve: Residence)<Apartment House❑ Commercial❑Trailer Court ❑ llMotel ❑Other........................................... t Number of living units:--- Number of bedrooms .-.---------Garbage Grinder ............ Lot Size ...9�.X F2............... Water Supply: Public System and name ........................................................._.......--..................................::......Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam Clay Loam ❑ Hardpan❑ Adobe 0 Fill Materlal ............if yes,type............... ............ (Plot plan, showing size of tot, location of system In relation to wells, buildings,_etc. must be placed on reverse side.[ NEW INSTALLATION: (No septic-tank-or se page--pirpentritred if pubtic sewer-inavailabk� within 200..feet,) PACKAGE TREATMENT [ ] SEPTIC TANK f.}�1 S7'`litr Size. -~ `:--------'-............ I f . Liquid Depth .......:.................. Capacity ....1N6.__Compartments .. p tY ----•--------------- TYPE aterial---._._..__....... - .,�.:............. Distance to"nearest: .' ..r .. w....... .. ., .. .r...... ._ Prop. Line ...s�..J......... F LEACHING LINE [ ] No. of Lines -------I:............. Length of each line......4�a...........-- Total Length _4/4>............... N 'D' Box ............ Type Filter Material ----_-------------Depth Filter Material ............................................. sal,, r~ Distance to nearest: Well ..,j"C?------------- Foundation .... &?l.._...... Property Line _....5-` .......... / r SEEF"E PIT [ } Depth 1Q._.---------••--• 9ierrrketery ....... Number ..._._f---------- ........ Rock Fil d Yes No ❑ V nn Water Table Depth -------•-• ..._...._--------- Rock Size it Distance.to nearest: Well ____52p.. -Foundation AC1.*.... Prop. Line . • REPAIR/ADDITION(Prey. Sanitation Permit# -----------------------------•-•--------- - Date ..................................I Septic Tank (Specify Requirements) •--, ---• - ., i! .----- -... ..... .2At.Q_.... Disposal Field (Specify Requirements) -------5q-Awla_--------------------------------------------------------------------------------------------- -------- -----------------------------------•--•---------------------•- ..................•------..........-...................................................... (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, andRules 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, l shall not employ any person In such manner as to become subject to Workman's Compensation laws of California." Signed ---------------------------------------- -------------- ------------------------- --------- Owner BY {.,iA.rl ! + --L �rGpl� Title (if other t an owner) -- -- --------------- FOR DESARTMENT USE ONLY APPLICATION ACCEPTED BY - DATE .., �f I +� BUILDING PERMIT ISSUED _... - "--- ..._.-------'--._........ . . ....................DATE --- ......................... ADDITIONAL. COMMENTS -------------------- --- ----- - ---------- ----------------------------------- ----------------••--------------- ..............------------------.-......... ----------- •----------- ........... -------•-------- Final inspection by: .--- ....... --•--•----------..Date......3-/V k EI 13 2h 1-68 ltev• 5m SAN JOAQUIN LOCAL HEALTH DISTRICT 8/71; 3M