73-1035 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ; APPLICATION FOR SANITATION PERMIT ,�b3s --------------------------------- - - (Complete in Triplicate) Permit No: .___`7_ _ _ __. -------- ----------------_-------------------------------- this Permit Expires 1 Year From Date Issued Date Issued __��J. 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�smade in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION _._. ____ �� ^�f G' p i -- ----- ----------------------------------CENSUS TRACT - 1 -7-------- Owners Name ----HiE -P, --------------------I---- --- --- Ph ne ------------------------------------- Address �'� d --------------------- City _ES �-('] � - it --- ------- License # ------- ------ Phone ------------------------_--- Contractor`s Name -_ _-__ _ . Installation will serve: Residence � Apartment House❑•Commercial ❑Trailer Court ❑ ❑ ------------------------- Number of living units.____I__.... umberoteof bedrooms ________Garbage Grinder Lot Size -- C ......... Water Supply: Public System and name ----------------------- /--------------- ----------------------------------------------------------------Private ®� Character of soil to a depth of 3 feet: Sand'o Silt E] Clay ❑ Peat❑ Sandy Loam -❑ Clay Loam zr_� Hardpan [FI.Adobe-❑ Fill Material __MCK If yes, type __________:____________ (Plot plan, showing size of lot, location of-systems in relation to wells, buildings, .etc. must be placed on reverse side.) NEW INSTALLATION:. jNo.sepfic tank-or_seep e;pit permitted if �blic sewer is available within 200.feet,) I! �J�. } PACKAGE TREATMENT [ 1 SEPTIC TANK'[ Size--__ X__f x_iLiquid Depth ____ ___________ Capacity - Q C7 Type P4 V_WED Material_Ca6(1CR_T_No.t Compartments --------- :. istance to-harest:-Well Le h o_each line_____ Q?n __-1�_- `--- Prop. Line -------Foundation , LEACHING LIN [ No. of Lines ____________________ g, f- Total Length _____� -________________ f �r 1 D' $ x Type Filter Material E - C__Depth Filter Material _______ .__-' .................. r Dista ce to nearest: Well ___ - ��___'j___--(Foundation -_-_lU___` # Property Line __ ____- _____ SEEPAGE PIT"s [ Depth ___I_____________ Diameter __ _ ______ Number - r- --- __�_ _ Rock Filled Yes -No [j i Wate) Table Depth ----------Rock Size Distance to nearest: Well _____l�_______________________________Foundation ___l REPAIR/ADDITION(Prev. Sanitaition Permit# __________________ Date Septic eeIr 1. -` `f .. Disposal Field (Specify Reurements)------ C "f ----- =`= `>r✓�' �_ 1 esi..._�-------- ------ 4 (Draw exiting and required addition on reverse side) I hereby cern 'that I have prepared this a lication and that the work will be done in accordance with San Joaquin y fY p p ' p c! County Ordinances, State Laws, and Rules and Regulations of the. San Joaquin Local Health District. Home owner or licen- sed agents si nature certifies the following: ` "I certify•'h winxthe perfor a of the work for which this permit is issued, 1 shall not employ,_`y person in such manner g to b 'a subject to Wo rf an's Compensat' n.laws of California." ! Signed :. Owner � � ^.t '�-(If-other than owner) FOR DEPARTMENT USE ONLY •©� APPLICATION ACCEPTED BY � r ------------------ ----------------------------------. DATE ..-- `-�---- ------- -------------- BUILDING PERMIT ISSUED ------------:--------------DATE ------------------------------------------- ----------------------------------- ADDITIONAE COA&MENTS - ---- ----------------------------------------------------- ------ __________ _________________ _ _______ __ ________..____.________-______________________-________-___--------__ ---------------------- ------------------ _ _ _ -.+- ��• �.. •rtir-.r-. ��i-�ru.u.wr.». . r'+-V•r- �F• .r+r�...wwa,s— ___ _ _______ _______ ___ ----------------- ---------- ----- ---- - - --------- ------ ........... ------------ j-- Final Ins ectio ____________________.Date -- p --- ----- - --- --- ------- - '---------- ---- ----------- SAN -- -- -- - SAN JOAQUIN' LOCAL HEALTH DISTRICT E. H. 9 1-'6$ Rev. 5M