72-114 - Laserfiche WebLink

Home Browse Search

'I FOR OFFICE USE: I APPLICATION FOR SANITATION PERMIT ------------------ ------------- ! Permit No. --7 Z' =-------------------------------------- i�---- (Complete in Triplicate) J Date Issued I! This Permit Expires 1 Year From Date Issued tj Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein II described. This application its made in compliance with County Ordinance No. 549 and existing Rules and Regulations. _/ 1 _nr� -__ JOB ADDRESS/LOCATION ____...____CENSUS TRACT __________________________ Owner's Name ----- A--,----- --------------------------------------------------------------- __-- -- --------- ------Phone -----------------------------•-•---- _ Address . -----------------------CitY " a Contractor's Name ------ y - - mm•Lic -ns Tra r' _ Phone ----------------------_----- ��-� License # - Installation will serve: ' Residences Apartment House°j] Co ❑ filer Court i❑ Motel ❑ Other -------------------------------------------- 11 1 F'` Number of living units:_______ Number of bedrooms _______ Grinder ._________._ Lot Size __.__-_________.________________________ Golfball�T Y A-------------------------------- - -- I Pea Sand Loam -------------- Private Water Supply.Public S stem and name - - --------------- �---------�-----;=-o---- ---`------•------•-----=----•------- Character of soil to a depth 'of 3 feet. Sand ❑ Silt ❑ Cay ❑ (X y ❑' Clay Loam ❑ ., Hardpan E] Adobe❑ ;Fill Material ------------ If yes, type --------------------------- (Plot plan, showing size o7f lot, location of system in relation to wells, ibuildings, etc. must be placed on reverse side.) N. 1` I , NEW INSTALLATION: (No septic tank or seepage pit permitted if. public sewer is available within 200 feet,l Gj PACKAGE TREATMENT { ]i SEPTIC TANK :[] Size_ __X__g____X__ ` --------- ------------ Liquid Depth ___q ------ ------- ,----- o Capacity -' Materia! -____tom`'"'__.__ No. Compartments Distance to nearest: Well ___-____ 60 ___________________Foundation ------ --------- Prop. Line ______ =� [ ] . of Lines --------I-------- ----- Length of each line -`Ill------------- Total Length ---------------------•-•---- Depth Filter Material---_________/�'_ ------------------------ LEA IN LINE Do Box _�_.__.__ Type Filter Material--s__�_____ -- p o �l � Distance to nearest: Well ----- .I'�----------- Foundation ----- --------- Property Line ------------------------ SEEPAGE PIT [ ] DeMpth ___________________ Diameter __________ - .___ Rock Filled Yes No ❑ Number ❑ WaterTable Depth --------------------------------------- I -------- Rock Size ----------------------•--------- Distance to nearest: Well -------------------------------- -----Foundation -------------------- Prop. Line ------_------------- REPAIR/ADDITION (Prev. Sanitation Permit #-------------------------------------------- Date ---------------------------.------I'- , Septic Tank (Specify Requirements) ------------ ------ Disposal Field {Specif iiRequirements) U�r` i q4^ ----------- -- -- - ------------------------------ ----------------- - - -------------' ------------------------------------------------------------ ------"---------------------------`-------------------------------------- Draw existing and required addition on reverse side) I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, State iLows, 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." Signed '------ Owner '----------Ti#le �--------------------------+ ------------------ ------ - ------- BY----------------------- `e+ fJ - (if other tha owner) it FOR DEPARTMENT .,USE ONLY APPLICATION ACCEPTED 1!BY ...t: -- -------------------------------------------- ------ DATE _.: .�_3" _------------------- BUILDING PERMIT ISSUED _------DATE ------------------------------------------- ADDITIONALCOMMENTS"-------------------------- - --------------------------------------------------------------- •---------- ------------------------------------------------ --- -----------------------------------------------------------------------------------------------------------------. --------------------------- Final Inspection by `�` `�t$" ---�------------------------------------------------------ - Date SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M,