73-735 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITA'T'ION PERMIT (Complete in Triplicate) Permit No. `j 3,-. �.• .. ............... This Permit Expires 1 Year From Date Issued Date Issued .....D.^ Application is hereby made to'the Sart 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 Regulationse 1 JOB ADDRESS/LOC ON :.'........ ..../. 0 ...:.:.........:........ CENSUS TRACT Owner's Name ...... 1 :.:. ......._._.. . ..........Phone. ....................... Address City ............................. Contractor's Name ...... ..._ G1 ,;---• ------------------------------------- -----License #'P7/5S 5.... Phone'/V6.J G"' Installation will serve: Residence�rtment House 0 Commercial-❑Trailer Court Motel ❑Other ...........................• ......... Number of living units:..__. .-.... Number of bedrooms .�•-----Garba a Grinder .111W_�� lot 5ze��tP �✓- „------------------•• I � Water Supply: Public System and name .................... Private Charocter of soil to a depth of 3 feet: Sand Silt clay Peat E] ❑ Y ❑ �andy Loam C] Clay Loam ❑ Hardpan (] Adobe Fill Material z!.. . If yes,type ...................... 4 ' (Fiat plan; showing size of lot, location of. system in relation to wells, buildings, etc, must be placed'-on,reverse side.) NEW INSTALLATION: (Nd septic tank or seepage pit permitted,rif-public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK ....._: •Liquid Depth ........................... Y � ] Size.------•.....-----•------------------- : � No. Compartments Capacity�y:#= Type ¢ Ma#erial ..... S # � �- �, Distance to, nearest; Well ..........:..... _..___...•Foundation . Pr i 0 op. Line ...................... LEACHING LINE _ '�'v"� _ 13 - No. of Lines ..... Length of each line---------------------- Total Length ............................ 'D' Box ....... Type Filter Material Dephf r 'rFilter Materia! ........... ... Distance to nearest. Well ` .. Foundation'...................•-- Property Line ............. SEEPAGE PIT [ ) Depth ............ ....... .Diameter Number ...... ................... Rock Filled Yes ❑ No Q Water Table Depth, z hock Size ...... •--- .................. ----........._.. Distance to nearest: Well ............................. _----- ArFoundation ...-•.-------------- Prop. tine ..-----•---- REPAIR/ADDITION(Prev. Sanitation Permit# ...:.............. Date Septic Tank (Specify Requirements) _....._ .................... ........ Disposal Field Specify Requirements) ` _-•.... �1.....- -'...� /l .. . 011 r , e boll ..----...•--..................... ..............•------------.._..--------..----.-•-------------......-- •-----•....--- (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. 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 Callfornia,” Signed ...................aert 4--------------_........ Owner By ....................f---•- ._ ----....... Title ...__ (If of owner) � - FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .._ . ...... / t DATE .... _.. ��l. ..... .. BUILDING PERMIT ISSUED -;......-•--- . :: DATE ....... ....................... .. ..... . .....-•............................I........................... ADDITIONAL COMMENTS " ' ..............................................................I -•----•---•--•---•---•••-•-------- .......-•----.-.....-•--...----................---..............--•-- ........_.....------•... .................. --- .... Final Inspection by: �(� ----•----•--..............•••• e -- -"}'ti'"-R`......... ...........••-----.........__,.. Date ... .:- C � SAN..JOAQUIN LOCAL HEALTH DISTRICT E. H. 13 24 1.'68 Rev. 5M 7/71 1