72-1048 - Laserfiche WebLink

Home Browse Search

{ v FOR OFFICE USE: APPLICATION-FOR SANITATION PERMIT ---- �- ------------ ------------------------ - Permit No: ---- _--------•---- (Complete in Triplicate) ------------------ -------------- --_---------------- This Permit Expires 4 Year From Date Issued Date Issued 1_________________ 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 complili+anc� with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS LOCATI "`� ------ -------------CENSUS TRACT -------------------------- :. , �.y--� Phone _ 6 -{S 7r�------------- Owner's Name --------- tftZ _�---- Address �_ .-----------. City cma ---- ------------- ---------------- Contractor's ---------------- Contractor's Name ------- __ ----- - ----- "-TL0 ------ ---�_ IBzr License # /CTOSt� - Phone 7 i—4-1f_4:....,...11 ..e...e. �U I PAdAonrP W Anrirtment House-171 r.Commercial '.Moiler Court '10 f � 9 L Address icense No.�t�a9.)-? Phone Contractor. 1 ,11 : Number o iving uni s:---- ------ Number of bearoams --- �----VUFUU-YC l7iTT1lJC1 '"" ZVP:l2V �_� --Water Supply:rPublic•System-dnd,name'-- _=-------------------------------------------------- _. . :___------- . ----- ate Character of soil to a depth of 3 feetz-,7, ❑,Y €Silt❑ " Clay E:] Peat❑ Sandy Loam Clay'Loam Hardpan ❑- Adobe'❑ Fill Material ____..___ - If yes, type --------------- ------------ Q (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) �a4 A , NEW INSTALEATlON: '(No septic tank or seepage pit permitted if public sewer is available within 200 feet,) / J PACKAGE.TREATMENT [ ] SEPTIC,TANK ize ---- ---------------------------- Liquid Depth _�-- -----------.-- a 'Capacity T - Type - -- - ---'- __ Material_�- 'u_. No. Compartments --z------------- Distance to nearest: Well ------- 7_- --'---------------Foundation ---:l_ - t'------ Prop. Line __. _...- ...... r LEACHING LINE No.;.of Lines_________---------- Length of each line_______� 5=- -- '-- Total Length _____ /-- ---------- - V �q Depth-Filter Material, _____ ,p' Box_ .7;_13_4 ___ Filter .Material _ __ _ __ _ -- p. ,ntt 4 l J J r Distance.,to nearest: Well __ --'r-_------ Foundation ' ��'�' `_ ~Rocker#y, Line _.. :.'-------- Y _._.--- \ SEEPAGE PIT [ ] Depth ��__;�__:'k��'-__ Diameter ________________ Number ------ -------------, ,Filled Yes,,❑` No .�❑ Q,: t Water Table'bepth-----------= =_ ay:__Rockr5ize- N _-� ,.;�w, EF A Distance to nearest: Well ----------------------------'` .-,:..-Foundation _,1__----- - _ ,'Prop.l Line"-:-_,=............... REPAIR/ADDITION(Prev. Sanitation Permit# -----------------------------:-------------- Dafie-- --,- ti -�-- ------- -- '�Y_rr v '� r ---------------�-- _--•-- `---- -----------------------•----------_--- Se tic Tank (SpecifyRequirements) -�.; j ,.--- .� Disposal Field (Specify Requirements) }=_:___.__,_-ry- -_ _t--_- - � ---------------- 4 - ----- -------------------------------- - � - ;� ----------------------------- . -- - -equi - the •work T .. - (Draw existingand required addition on reverse side) 1 hereby certify that I have;prepared this application and that will be done in accordance with San Joaquin County Ordinances, State Laws,_an..d_Rules_and Regulafi ons_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." ' 41 Signed ----------- ------------------------ Owner r ------ Title --- t (If oth han owner) i - -FOR DEPARTMENT VSE ONLY APPLICATION ACCE TED BY ----------- �a ,� DATE - - -------- BUILDING PERMIT ISSUED -------------------------------------- ------ DATE ADDITIONAL COMMENTS -------------------------------------- `---------------- ----•--------------------- --------_---- ----------- - - ------------------------------------------------ rre..— -------------------------------------- ------------- ------= ------------------T: -,------ --- ---- -------------------------------•------ --------------------------------------------- - ----- - ---- ---- r - Final Inspection by: 4 G� s - t ,f ------Date w-:.--� �' ---------- �-� y t SAN JO QLI(N LOCA-LOCDISTRICT E. H. 9 1-'b$ Rev. 5M �.