73-519 - Laserfiche WebLink

Home Browse Search

A FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ' 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: JOB ADDRESS/LOCATIO aya - __! --------R D-------.--- -CENSUS TRACT _----- # ------- Name --------- ---'---� �-- -- - - � L, �, / R_S --------- ----Phone------------------------------------ Owner's Address ------- �_ � ----------- ��/V fV!_1 V_-------- City L_►_I_ r-V ` lel - `:c „ --------- �----------=--------License # Phone ------- Contractor's Name -___�____._-__ - �, _,r r Installation will serve: Residence partment Ho e,❑ Commercial.❑Trailer Court 'I[] Motel ❑Othgr ------------------------------------------- Number of living units:------ Number of bedrooms -3-----Garba_ge Grinder - Lot Size`_____________ Water Supply: Public System and name -_____._-------------- ___---------------- ---Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat E.1Sandy Loom E"' Clay,Loam [_1T � Hardpan F1 Adobe F1Fill Material _/_/_-- 1f yes, type ____________________________ V [Plot plan, showing size of lot, location of system in relation to wells, buildings, etc, must be placed on reverse side} ,l NEW INSTALLATION: (No septic tank or seep ge pit permitted if iic(sewer is available within 200 feet,) / O r s^____ Liquid Depth __ - PACKAGE TREATMENT [ ] SEPTIC TANK Size_____ ..... -X------- 'j Capacity f ad--- TYp'e�r� _ Material�_�_d ,_Compartments �._r.---1- =.... Distance l2 to nearest. Well[ ___.--�(r_- --e-Faundation lQ '� Prop.-L"inei___ - -_____ if LEACHING LINE [/No. of Lines __ ---- ______ ___ Length of each -lirie_.k_��Q-------------- Total Length -__--�1.Q.----------- If i De th" Filter Material -___. 9------------------ D' Box _ a Filter Material ----r--�- i "' r ��..� Yp _ pig nce.At�4oneatest: Well -- =--- Found,ation�__� __ - Property Line --- --�4,------..._.',-- i e ti SEEPAGE PIT [ ] Depth -------------------- Diameter Num e ---- ------ Rock Filled Yes ❑ No i❑ Water 76bfe Depth Rock Size y p 4' -------- -- --------------------- ! " Distance to nearest: Well ----------------- --------- Foundation --=----------- ---- Pro Line -------- .J`'..---- j / REPAIR/ADDITION(Prev. Sanitation Permit# ------------------------ Date -----------------------==---- ] i l Septic Tank (Specify Requirements) ----------------------------------------------------------------it - Di posal ,Field {Specify RequirTeints) ----- -��----------------------�06------------- W1-0 ,------- x ' ---------• -----------•-- -------------------------------------- s i f ' ,; — __ -------- _: - --------------------=---------------- r ----------------F--------- - , (Draw existing and required addition on reverse side) 0. I hereby certify that 1 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- I sed agents signature certifies the following: "I certify t n he pe r ante of the work for which this permit is issued, 1 shall not employ any person in such Winner as to bec 'e su jec to an's Compensation laws of California." + Signed ------------------------------------------ Owner By --- ------ ---- ---------------- - ----- ------ I-----------------77t-A---0--------- Title . - ----- -------- -- ---------------------------------------------- Ilf other than own6r) I FOR DEPARTMENT USE ONLY J APPLICATION ACC(=PIED :8Y rY ` '�----------------- ----D- ATE f .. BUILD.ING_PERMIT,:-ISSUED._-=--- --------- `-�---------•----- ----- - DAT.E-------------- ADDITIONA - - ADDITIONALCOMMENTS ------ ----- ----- -------------------------- -------- ----------: ------------ - ------------- ---------- -- - — -- ------ ------- / ` ----- - -------- = -- •-------- -- -- - - e (� -- --- -- - - - Final lnspectio --- ----.Dat SAN JOAQUIN LOCAL-HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M