73-418 - Laserfiche WebLink

Home Browse Search

FOR OFFICE IJSE: , r y� APPLICATION FOR SANITATION PERMIT Permit No. 7 -------------- --- --/------•--------------------------- - - F (Complete in Triplicate) -------•-•--- 4 ..........I---------------------------------------------- ____.__________________ _______.__-____.____--_____ 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. } I JOB ADDRESS/LOCATION -7 ----------- f d_A—ev- _Q_-/..... .P,-,:Z----_____-----------CENSUS TRACT -------------------------- "7-VA, _----.____.______________ . t 4 Owner's Name ?'? -----a11_Q-_! _r1�✓---------------------------------------------------------------_---- -------------Phone --------------------------•--------- Address _f 747a_(,___25----- --5�"Av_ ev-L----I`-P----------------- City _ /3 7�I—Q� ------------- S { Contractor's Name --- __, e1 ---------------------------------------- ---- -License ---- Phon ____�_--------- -- Installation will serve: Residence [Apartment House❑ Commercial:❑Trailer Court ❑ Motel ❑ Other -------------------------------------------- Number of living. units:-------/__ Number of bedrooms ----_��___...Garbage Grinder ------------ Lot Size ________________ ---------------------------- WaterSupply: Public System and name ----------------------------------•-------------------------------------------------------------------------•--Private Jq ` Character of soil to a depth of 3 feet: Sand'S Silt❑ Clay ❑ Peat❑ Sandy Loam -❑ Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material ----- ------ If yes,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,) {� PACKAGE TREATMENT [ ] SEPTIC TANK [ J Size___________________ _ ----------__ Liquid Depth -------------------- Capacity ______________Capacity -------------------- Type ------------------ Material----------- ---------- No. Compartments ---------------------- VN: Distance to nearest: Well _______________ __________________Foun ation ---------------------- Prop. Line _________-_------- LEACHING LINE [ ] No. of Lin ies ________________________ Length of each line---- ______._______..____-- Total Length ____________________________ 'D' Box --- -------- Type Filter Mater' I -------------------- pth Filter Material --------------------.--------------------_._ i Distance to nearest: Well __- Found ,on ______________________ Property Line ________________________ SEEPAGE PIT [ ] Depth ____ ______________ .Diamete Nu er _________________.__________ Rock Filled Yes ❑ No i❑ Water Table Depth ----------- -------------- -----------•- ----...Rock Size ---------------------------••--- Distance to nearest: Well ________Foundation ____________________ Prop. Line ________--____-___--__ i REPAIRJADDITION(Prev. Sanitation Permit# _____ .__---------________________________ Date ____-___________________________) i Septic Tank (Specify Requirements) ____________________________________ Disposal Field (Specify Requirements) - w ---------6-5' f ,_ ,_[. i - -----'--- -------------------------------------- ----------------------------------------=--------- -------------------------------------------------------------------------------------------------------------------------------------------- I (Draw existing and required addition on reverse side) t 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 ____ 5 ----------------------- Owner -- --- ------ Title --------- ----------------------------- N='(If other than owner) FOR .DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------- e DATE -----`�� ` - BUILDING PERMIT ISSUED------------- ------------ -------- --------------DATE ------------------------------------------- ADDITIONALCOMMENTS # ----------- --------------------------------------------------------------------------------------=--------------------------- --------------------------------------------------I-------- ------------------------------------------------------------------------------------------------------------------------------- ---------------- ------------------------------------------------ -------------------------------------------------------------------------------------------------------- ------------------------------ -------------------------------- -- ,�a} - - - ------ - - - - - - - - - - -------------------- - Final Inspection b (�_�"__-o-- ------ ------ ---Date ......+.a- ----------!4_u = # SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M � i