71-512 - Laserfiche WebLink

Home Browse Search

_FOR OFFICE USE: APPLICATION FOR.SANITATION PERMIT -----------------� (Complete in Triplicate} Permit No. _71:751.2______. ---------------------------------------------- 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/LOCATIO .f�7_�z--�ypo�a� ------ A-Orla-- ---------------------------------CENSUS TRACT -------------------------- ---�.d� ------- �!/ - 101 - ------- �=- --------------Phone ��5=-1-9-77 Owner's Name __________ Addressy /- - City Contractor's Name ________________ ` UTt/J-------- ----------License # -------- Phone /443 5/xb6- _6d Installation will serve: Residence Apartment House❑ Commercial:MVciil.er,Court_❑_ Motel ❑Other ---------------------------------------/ Number of living units_____________ Number of bedrooms ____Garbage Grinder -----_- ___ Lot Sze _____ --- �-------.---- Water Supply: Public System and name ---------------------- ------------- -----------=/-- - -------------- ------Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay 0� Peat❑ Sandy Loam ❑� Clay Loam ❑ Hardpan ❑ AdobeFill Material ____________ If yes, type __________ _______________I f �s (Plot plan, showing size of lot, location of system in;relation to wells, buildings, etc.-must-be-placed.on..reverse side.) NEW INSTALLATION: JNo septic tank or seepage pit permitted if public sewer is available within 200 feet,) , �'`► PACKAGE TREATMENT [ 3 SEPTIC TANK'[ ] Size------------------------ --------- ------------ Liquid Depth ------------------•-------- � ..A Capacity = .Type ------ ------------- Material---------- ------- No. Compartments ---------------------- Distance to nearest./Well -_______.__________________________ p. -Foundation __________________---- Pro Line __________________._ LEACHING LINE [ ] No. of Lines --�_._______ Length,! f each line________________ _________ Total Length -_-_____-L_--_-__________.. t,;x� I 'D' Box Ij,:_-___ 'Type Filter Material �____-+_'-_'----Depth� Fitter Material =_______�___________________�___..---.----.- ..A i . .: Distance to nearest: Well ________________________ Foundation -__>______�ii_-_________ Property ------__._..__.__._.___ SEEPAGE PIT [ ] Depth�___�lr""�`-______ Diameter ________________ Number -_-.------.___1_.__________ Rock Filled Yes 0 No ❑ 14 dater TableNDepth------------------------------------------------Rock Size J---------------------------- I Distance to near st Well---------_-_-_-_____----- Foundation ____._____-_______ Prop. Line ______________________ I f REPAIR/ADDITION{Prev. Sanitation Permit# -------------------------------------------- Date ---------------------------------- Septic ---------------------------------Se tic TaAkti(Specify Requirements) ! `---------- ------------------------------------------------------ Disposal Field (Specify Requirements) ----- -Gf------------ ---------- ------------- ---R`-'- t----------------- V It 1 --------------------------------------------------------------------------- - -dam_------ - �------- -c- ---------------- --------------------- --------------------------- - ---------------------------------------------------------------------------------------------------------- (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 become subject to Workman's Compensation laws of California.";. i . t —6 -- - Signed ---------- -----4------------------------------------------- Owner BY ------ -------- R --- -------------- - ------------------- - Title ---- ----- ------------ -- (If other n owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---- ------- --------------------------------------------------' l---- ------------- DATE ---5- �� ------------------- BUILDING PERMIT ISSUED ---------------------------f------------------------------------------------------------------------ ---DATE ------------------------------------------- ADDITIONAL COMMENTS ------- ------------------------------------------------------------------ ------------------------------------------------ --------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------- --------------------------------------------------------------------------------------- ----------------------------------------- --------------------- ---- ------------------------ Date - ff 4---- -`------Final Inspection-b-y--:----- 'I- - - - - - ------ SAN JOAQUIN LOCAL HEALTH DISTRICT F 5 E. H. 9 1-'68 Rev. 5Mja�„�¢ ,L- { C