73-492 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT .......... ...... 10)l Permit No. (Complete in Triplicate( f ....................................................... -3 Date issued _.(.-.O...7. This Permit Expires I Year From bate Issued i Application is hereby mode to the San Joaquin Local Health District for a permit to constructa nd install the work herein described. This application is mo e in compliance with County Ordinance No. 549 and existing Rules and Regulations: -2–oCoS ACT JOB ADDRESS/LOCATION ....... .. .... ...... _ - ---- ---- - ....CENSUS TR ---------- Owner's Nome e..................... .��.. .......Phone .,C?eXZe,9,F 0 ------_------------_-•........... 13- Address ---------- ---------------- city V) 7 Contractor's Nome --'----.-.License # 7177- Phone,2C Installation will serve: Residence AApartment House-E] Commercial Effrailer Court 0 Motel M❑Other ------------------------....-"---------- Number ---------- .,X Number of living units:._/.... Number of bedrooms .......Garbage Grinder--19'7- Lot Size ..... Water Supply: Public System and name ------ ........... ------------------- --- .............. ---------Private it 41 Character of soil to a depth of 3 feet. Sand t. Silt-E) . Clay El Peat El Sandy Loom [D Clay Loam Hbrdpon E] Adobe 0 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,( PACKAGE TREATMENTSEPTIC TANK r>r Size../.0'- ........ Liquid Depth ...S.................... Capocity/90� Type Material... No. Compartments _-A–-----------_- 4 Distance to*nearest: Well ..-.-.---...,Foundation -iProp. Line, –_-o- ............ — LEACHING LINE No. of Lines Length of each line Total Length ........ 'D' Box Type Filter Material ....._Depth Filter Material ------------------------ 4 . Distance to nearest: Well ------ Foundation Property Line ...!67............... SEEPAGE PIT Depth ------ Diameter ..............__ Number ...... Rock Filled Yes 0 No CC) ----------------_- . .................... Water Table Depth .... -------_------_---- Rock Size _ ...... Distance to nearest: Well ---------------------------------------Foundation ............ ....... Prop, Line ............... ...... REPAIR/ADDITION(Prev. Sanitation Permit# .... ...................... Date ----------...................... Septic Tank (Specify Requirements) ---------------------------____.................................................. ........................................ Disposal -Field ISpecify Requirements) -------------------------------------------------------_........... .......................... .................... ---------- .............................. --------------------- -------------------------- ..................... ..........---------- .......... ............ ......:-------I------- ------- .......... ......................_. (Draw existing and required addition on reverse side) I hereby certify 1kal-J.-have prepared this application and that the work will be done in accordance with Son Joaquin County Ordinances, State Laws, and Rules and Regulations of the Son 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 net employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed ....... ...... .................................... Owner By ... ...... Title . ....... .. (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED I ...... ...... ---------- -- DATE .... ........ BUILDING PERMIT ISSUED ............................... ........... . ----------- ------- -- ....... .. .. ...... DATE . .......... ------......-•-- ADDITIONAL COMMENTS ....... ------ --------------------- .... ...._---------- ...................___....................... .......... .......... ....... ... ................ . ---.- -- -- ... .......... ................. ........... ......... ------------------------------------- ................. .. ........ . ................. ------ .-.-.-.-- ..... .......... .......................D--o--t-e---- _ Final Ispectio ... ......... .. SAN JOAQUIN LOCAL HEALTH DISTRICT 7/723 .4