72-946 - Laserfiche WebLink

Home Browse Search

FO,D OFFICE USE: x APPLICATK-)N FOR SANITATION PERMIT ----------------------------------------------- =--- -=,---------------------------- (Complete in Triplicate] U� ,, //Wo Permit No. ---------------------- V—?Z-- (s. q ------------- �` This Permit Expires 1 Year From Date Issued Date Issued -f/i-/.L 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 C u y Ord' once No: 549 and existing Rules and Regulations., / 077-3 ..4,a g JOB ADDRESS/LOCATION ._Alae/✓C'i� Gjfgj� f /`�_ ' rYJ_l�l.V_CENSUS TRACT Owner's Name ._-___��.�,-___-��_�- ��-z- ------------------------------------- -- Phone --------------------- Address 77 5 1 / �,'V_9712 ----------------- City ��L Contractor's Name _._ .�' f— `- License # ��1 Phone6.6 7- /c/ Installation will serve: Residence ❑ Apartment House-E] Commercial []Trailer Court i❑ Motel ❑ Other ----------------------- ------------------- Number of living units:-----I----- Number of bedrooms ___Z_--Garbage Grinder ------------- Lot Size ater Supply: Public System and name -------- __ -_ ' ---- ------------------------ - _ _ Private ❑ Character of soil to a depth of 3 feet: Sand Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam E❑ 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:[ ] Size--------Za-jc'_1:5__ -57------ Liquid Depth _ Capacity 41P6_------ Type P_U ------------? Material__ �o. Compartments Z a ---------------------- Distance to nearest: Well ---------4 ---------------Foundation __._/-�----_- ---____ prop Line _ _ _�___ � LEACHING LINE [ ] No. of Lines - Z g -- V -----_----- Length o each line_----- ---�_--- .--- -- Total Length ____�� 'D' Box -------- -- Type Filter Material _ -a1k__Depth Filter Material _/.//- Distance to nearest: Well ---__16Z-------- Foundation ---l-_U- ----- -- Property Line -��--------------_ SEEPAGE PIT [ ] Depth ____________________ Diameter ---------------- Number ---------------------------- Rork Filled Yes ❑ No Water Table Depth ------------------------------------------------Rock Size ---------_----- - - -------•------- Distance to nearest: Well ___________ _____-___--Foundation ----------- Prop. Eine ----- ---------------- REPAIR/ADDITION(Prev. Sanitation Permit# -----------------.___--_ ) --------- --------- Date ---- -----------•-- Septic Tank (Specify Requirements) -------- ------------------------------------------------ Disposal Field (Specify Requirements) -- --- -------------------------------------------------------------------------------------------- (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 Workma 's Compensation laws of California." Signed -- ---- . ----------------------- Owner --------------------- BY Title -- --------------- (if other than owner) - ----------- FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY __. _ -- �7 BUILDING PERMIT ISSUED ._ --------------------------------- DATE 7 Q- -- r --------- ---- C -b•.�---Q------ - DA -- -- ;-.----------------------------------------------------- - DTIONA COS ------------AD ------------------ -------------------------------------------------------------------------------------•--------- ------------------------- -- - ----------- ----- -----------------------------------Final Inspection b ---- ---------------------------- ---------------------- ------.Date ------- SAN "t --------- JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M r�