72-910 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT - -------------------------- ------ � Permit No. --------------- {Complete in Tdplicatel ---------------------------I----------------- Y iS 7 v Date Issued ----9.------------ ----------------------------__- ---- 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/LOCATION ._�?DG---?-Q--------err-----A-7-1�M14�--XA1---------CENSUS TRACT ._ - ---------_--- Owner's Name ------DAIJo--- -------v-A--V-.0--N-,C-------------------------------------------------------Phone Address ---- ---rf-;7-/J---------cfe_.04Y----•----/—A/------------------------------------- City ---- T_27/,�'------- -------------------------......... Contractor's NameAVE-------,5 3177e---------`5-•Fe 'x-----------------------License # 47-�> Phone ��1.�=✓�a��_. Installation will serve. Residence Apartment House❑ Commercial ❑Trailer Court ;❑ Motel ❑Other -------------------------------------------- Number of living units:---sY Number of bedrooms --a------Garbage Grinder f-O___.Lot Size --a_47..... �� ------------ Water Supply: Public System and name ------------------------------------------- --------------------------- --------------------------------------Private„A' Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ 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,)If O PACKAGE TREATMENT { ] SEPTIC TANK 56 Size__� 01 ------------------- Liquid Depth __41.........._________ Q Capacity�� ' �-- Type , -Material_Z:2W�//-7_rNo. Compartments 0�_ .________________ q� Distance to nearest: Well .......................Foundation la------------- Prop. Line _S�_---______..._--_ O LEACHING LINEf(] No. of Lines _._.2-------------- Length of each line----�`O_�____._._-__ Total Length ------------- No. 'D' Box IOP5---- Type Filter Material k4C /'____Depth Filter Material l -"____________-------------------- Distance __________ _______Distance to nearest: Well ___,�;7"Q___________ Foundation ---------------- Property Line ----------------- _ / it SEEPAGE PIT X/1 Depth ---o�.�_____---_ Diameter _________ Number ----- ------------ ------ Rock Filled Yes-T No C1 Water Table Depth --.2ew---------------------------- -------Rock Size !1-. ----------------- Distance to nearest: Well ___ ----------------_--------Foundation ---!.Q----------- Prop. Line _-S-.1 REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date __________--- ..______________-_-_) SepticTank (Specify Requirements) --------------------------------------------------------------=--------------------------------------------- ---------------------------- DisposalField (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 r 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: "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-claws of California." Signed ------------- ----- Owner ------------------------------------- BY - -- �t _ --+ Ae -a- ----------------- Title . -�i {lf o r an FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY . �y,�f -------------------------------------------------------- DATED - 5 -7��--------------- BUILDING PERMIT ISSUED ------------------------------------------------- -- ----------- -- - -------DATE --------- --------------------------------- ADDITIONALCOMMENTS ----------------------- --------------------------------------- -- --------------------------------------------------------------------------- --------- ---------------------------------- _ _- _---------------------_-_--------------- ---------- ----------------- -- -------_----------`~-------------- ------------------------ - Final Inspection by: _ _ Date _ ---YJ_3_'_ - ._ SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M