73-580 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 00 ...-...._ -•--•----....-. ------------- t i Permit No. 7�..' .� r,. ..� (Complete in Triplicate) �� Hyl � _ • Date issued .67. Sr.25 ....-•--•--•----•.................................... This Permit Expires 1E Year Front Datelssued Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations= �. i rr JOB ADDRESS/LOCATION .._..... --- �1�_.._�.®N�...�p._�.. ....:....CENSUS TRACT ........... ......... Owner's-Name ---.......� .........:..............:........:..:.........Phone ._ ...... ®-w� . ................. . . Address - .__. City . .� •..... Contractor's Name '_' �f Ai sne - ..License #A6- _ �-�..---- Phone ...---_.. ---•- ' S 9 Installation will serve: Residence IX Apartment House 0 Commercial []Trailer Court p I `,y I Motel 0 Other Number of Living units ....... Number of bedrooms ....?-__'....Garbage Grinder ............ Lot Size *?o...l . ................... Water Supply: Public System and name ........... : .......s---.._ .................... =-•---- ...........................................-.... Privatez . Character of soil to a depth of 3 feet: Sand E] Silt j] Clay M—• Peat 'Sandy Loam ❑ Clay Loam. Q J Hordpan [], ' Adobe [Fill Material .......... If yes.type __.____.....--- ....... {Plot plan, showing size of lot, location,of Aystem.-inIrelation 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 240 feet,) l PACKAGE TREATMENT [ SEPTIC TANK- ' . " ` iSize.......�a �-- ---- Liquid Depth .. `tG .-........ f � � . - � =Cis¢.- Material_. _ ''' No. Compartments .`. ............... Capacity .�-.....---�''�-- Type ...._.. - t'' Distance to nearest: Well .._.l..aa`.`.........:..:...Foundation Prop. Line ...................... �1 LEACHING LINE [ ] No. of Lines .-..- ---------.-- Length of ach line-------0$r............. Total Length .._�_Z ?. .........?. J r. 'D' Box _2..... Type Filter Material _ .._b .....Depth Filter Material ___ .....................7............:. -r� �o " S•fi ... .� O Distance to nearest: Well .___fes._.______ Foundation .... . ...--„_. _-_ Property Line _._.__.. .. SEEPAGE PIT [ 7 Depth -------- Diameter .3.3....... Number -----�.....-.__..___-_. Rock Filled Yes (S--, No Q rr = Water Table Depth ....._.._�.r`F---...................... Rock Size -•------------------- --�- Distance-to nearest: Well _...___ . ___---_.- • ---Foundation ... ................. Prop. Line --- .._.............. w REPAIR/ADDITION(Prev. Sanitation Permit# i .................•-_.........--•-------• Date .... .................. t y Septic Tarok (Specify Requirements) ----------------- --•------._.......,--------•---•---- ........... -----------•••-••---:......__ ................ A-................. • f Disposal Field (Specify Requirements) ,- i ....................................3.---•--------_.... = ---------------- •......................................•._.---._1._....:.-- ......................;.-------------••-^--•---------...................-- ..--_... •--------- ..:.......:............ (Draw existing and required addition on reverse side) 1 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. horn* owner or liven- sed agents signature certifies the following: ; "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California.” � Signed ------• -- • .� �. � Owner ................................................... ............................... ...................... ........ . BY __- .... • - 3iNe ._ ...... (If other than owner] [ aZ�FPARTMENT USE ONLY • ................. I APPLICATION ACCEPTED 8Y .,-_-• . .... .. r. . ._ ... .. ...�t .................................... DATE -�-J:.3.�� ' BUILDING PERMIT i55UED - __ _ ----.--,DATE^ ...................•--•--- ""'•"---. .- ADDITIONAL COMMENTS •-- .............•..........- �. ....--- ' ....... .....................................•--•-- f. ...................................._.._._....•--•--.....-._..--•-•-•-•.._..._..........-•-.....__._..... ..... ........ i ------------• --•-- -.. - •:..... .. .. ........................:............................ - -- .... ..... . .. ... Final Inspection by: ............................................Dae ._.__ .._. ._ ._.__.. - t •.. SAN JOAQUIN LOCAL HEALTH DISTRICT C L3 24,_-An D.- gm - - _ 7/723 ,1