72-945 - Laserfiche WebLink

Home Browse Search

i FOR OFFICE USE: APPLICATION FOR SANITATION PERMIY Permit No. --..-__""-""--------- (Complete in Triplicate) ------------------------------------- --- --- ------- Date issued --- ------ --------------- This Permit Expires 1 Year From 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: ) .-- JOS ADDRESS/LOCATION _��Q- .f'i41��-- ---- - --------CENSUS TRACT __-"----""__--. -.- - - - Owner's Name -,F -� , P" '--7=------------------------------- ----- - --- - ------Phone ----------------------- �✓ / - Cittd . ! ic Address ------��'C� ----� Q------- Q-'-�- - --------- ----------- - -------- � Y - .d Contractor's Name --- i� � � - --------------- License Phone 1( © '9r-----•-- Installation will serve: Residence F] Apartment House'E] Commercial XfTrailer Court 'E] Motel ❑ Other -M-"-e-1--------------------- Number of living units------------- Number of bedrooms ------------Garbage Grinder ------------ Lot Size -- - - -- Water Supply: Public System and name ------------------- - --------------------------------------------•-- ----- Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ s 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,) SEPTIC TANK Size------. --- Liquid Depth "----��---.-------- PACKAGE TREATMENT [ ] [ l 2-1 Ma#erial-GGgc No. Compartments ------------------- �. Capacity lQ Type ------------------ t: r- f f -.Foundation ------------ Prop. Line ------------•- pistance to nearest: Well ""__�l�P-"------------------- LEACHING LINE [ ] No. of Lines ----."-I ------------ Length of each line-------�p Tota! Length "_-""-"��------• � F, -"P r �i z*F Type Filter Material � -X Depth Filter Material _-----� "---------------• D' Box YP � Distance to nearest: Well ----/-&-0---------- Foundation ------------- Property Line. """_"- ---------- SEEPAGE PIT PIT [ ] Depth -------------------- Diameter ---------------- Number --------------------------- Rock Filled Yes [] No WaterTable Depth ------------------------------------------------Rock Size -------------------------------- ! Distance to nearest: Well Foundation -------------------- Prop. Line ---------------------- f REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------- ----- Date _---------------------------------) Septic Tank (Specify Requirements) ---------I----------- ---------------------_0---------------- ---------- Disposal Field (Specify Requirements) -------------------- -- -------------------------------------- -------------------------------------------- --------- ------------------ -------------I--------------------------------------------------------------------------------------------------------------------- - ---------- (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 ect to Workn)gn's Compensation laws of California." Signed ------ -ems" -c t c`/ - -------------- Owners .. Title,e/ !f ' Lcx BY ------------------ -- ----- !/ (if other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - d DATE c� a - rZ ----------------- BUILDINGPERMIT ISSUED - ------------- ----------------- ----------------------------=--------------DATE ADDITIONALCOMMENTS -------------- ------------------------------------------------------------------------------------------------------------------ ------- -- --- - . Date Final Inspection b SAN JOAQUIN LOCAL HEALTH DISTRICT F- H- 9 1-'68 Rev. 5M -