71-972 - Laserfiche WebLink

Home Browse Search

M FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ------- 3- (Complete (Complete in Triplicate) Permit No. !-._ _7_.__. This permit Expires 11 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: v __CENSUS TRACT --------------- .......... ADDRESS/LOCATION .-- cl - -r- -�'•----� /--- ------------------- -- -- Owner's Name .------a-44-1----- -D,----K/ f ir_.-----•-- ------------------ -------------------Phone --------------------- - Address ---/324X7---- - ------------------------------------------------ City ---- ------------------------------ •---------•---•----•----- Contractor's Name ---W.Z_ --- ------------=-------------License # --- Phone Installation will serve: Residence N Apartment Housef] Commercial ❑Trailer Court i❑ Motel ❑ Other -------------------------------------------- . Number of living units:--_/------ Number of bedrooms __s. ___Garbage Grinder ------------- Lot Size _._ --------- Water Supply: Public System and name __ -rl _�'rJ- F __________Private -------------------------------------------------------------------- Character of soil to a depth of 3 feet: Sand'E] Silt❑ Clay ❑ Peat❑ Sandy;Loam ❑ Clay Loam�s Hardpan IM Adobe.E] Fill Material ------------ Ifiyes, type __-_--_.--_______--- (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,) ` W PACKAGE TREATMENT I ] SEPTIC TANK!X Size----- _cSx_J4______________________ Liquid Depth -------�/__________-. �1 Capacity 1 ------- Type _P Material---_---_ No. Compartments ------�------.--. Distance to nearest: Well ----------LI-49._................Foundation -------/4......... Prop. Line ._.._.. ........ f/1 LEACHING LINE X No. of Lines g g ------------- Length of each line------144-------------- Total Length ____cx _d - 1 'D' Box ----,�----- Type Filter Material -- -----Depth Filter Material _________��-__ - --•---------------- Distance to nearest: Well __._ ------------ Foundation _______ -------- Property Line ________ r--_------_. SEEPAGE PIT Depth --- s--------- Diameter Number ------------o ----------- Rock Filled Yes No ❑ Water Table Depth ------- -14 --I---------------------------Rock Size --------a2 �1--------- Distance to nearest: Well ---------Ap4-r...................Foundation --___----- --- Prop. Line ----- --------- REPAIR/ADDITION(Prev. Sanitation Permit# ____________________________________________ Date --------.---------------.......... ) SepticTank (Specify Requirements) ----------------------------------------------------------------------------------------------------------- •------------------ -•---- Disposal Field {Specify Requirements) ---------- --• - --- -----------------------------------------------------------------------------------•--------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------ ----------------------------------------------------------------------------------=-------- ------------------------------------ (Draw -- ------(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: "1 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." Signed y�-------------------------------------------------------------------- �-----------------------. Owner BY //r the-�f--� x' r------------------------ � �Z!/`� >-- - �tto-/--- Title ---------------------------------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----- ---------------------- -----. DATE _L _' '� -7L --- -------- -- BUILDINGPERMIT ISSUED ------------------------ --------------------------------------------------------------------------------DATE ------------------------------------------- ADDITIONALCOMMENTS - ---- -------------------------------------------------------------------------------------------------------------------- ----- ---------------•----------- ------------ ------------------------------------ -------- ------------------------------------------------------------------------------------------------- --- ----------- ---------------------------------- - -- - Final Inspection by: Date - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M