75-71 - Laserfiche WebLink

Home Browse Search

FOR OFFICE U E: y ......... 3 APPLICATION FOR SANITATION PERMIT r Z p ------•-. {Complete in Tripltcatel Permit No.215_ ---------- .............. This Permit Expires 1 Year from Doh Issued Date Issued ...04910,.2:$— 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 Count Ordinance No. 549 and existing Rules and Regulations: G� Q JOB ADDRESS/LOCA TIO ./. 2Q Owner's Name ..__.... � � CENSUS TRACT -L. o hone I, . Address - G �......... City . . . .. . ., i 1. °2 Contractor's Name _. .......License # 3' M.. Phone Insiallotian will serve: Residence ent House❑ Commercial ❑Trailer Court C) Motel ❑Other , , t Number of living units:--/....... Number of bedroa s .Garbage Gander ............ Lot Size .. ls� . Water Supply: Public System and name .� -...._�...y..............................................Private -•--..._.. Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay Q Peat�r Sandy1oam {] Clay Loam-❑ H v and an Adobe ill Mpterial ..._........ If'Ves,typ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be.placed on reverse side.) NEW jI+ISTALLATfON: (No septic tank or seepage pit permitted if.public sewer is available-within 200 feet,) PACKAGE TREATMENT ( 7 SEPTIC TANK ............. .. Liquid Depth .. Capacity TYpe: Material. No. Compartments ........... No. of Lines ----.. w,.:.F:.. { , Distance. to nearest: Well ------. ..........................Foundation...................... Prop. line ..........I.......... . LEACHING CINE gth of each line...........•................ Total length ................... 6 � V Box Type filter Material .........Depth .Filter Material Distance to nearest: Well --------- Foundation 8........................ Property Line .. SEEPAGE EEP'°'w GE PIT Depth Diameter -.-- N umber .._....._. ----------------- Rock Filled ' Yes ❑ No C3F Water Table Depth ..................................... ......Rock Size ................ Distance to nearest: Well ................................:.... Foundation ._.... ..... . ..._. Prop. kine ...................... t/ADDITION(Prey. Sanitation Permit�# -=------.---.... ..:... . ......:3_._ Date �..------- .__._...............-) (o REPAIR Septic Tank (Specify Requirements( C�.__ (a- sl Disposal Field (Specify Requirements) ------•---•-----------------------------------------•- ---•••-•------------- -- ------. __- --- . ----------------------- ------•-- ---- - ---------------•----. ............_..---•--.....---------•------- -- (Draw existing and required addition on reverse side) r F hereby z ectify 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 this an 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, l sh It not employ any person in su manner as to become subject to Workman's Compensation laws of Californiri." Signed --- - �- t g - - ---�---- ---- ------••--------------•--•=----- -._ 0 wrier .. h$Y -- -- - -•------------•-•---- Ti to _. �-�s ---------- ------------- f: (if other than ner) ' } Yr' i�sp i.k� t�r � • Y A FQR DEIARTN4ENf LlSE ONLY APPLICATION ACCEPTED`BY 3 D �� - ------------------------- ----- ••---`3:,9. ATE 1.. ----_.. :13[liLDING PERMIT ISSUED -•-- ` TATE ..._ --•-•- ,: AWITIONAL COMMENTS------- ---------------------------------------•...............I------ .................. ..........I a, 4k�� - ._...s........ ------------------------ ............ _ --------------------------------------------------------------------------------- >: ..------------- ............... Final Inspection by <= '-•• ----•--- ... •-------- ---------Date �J EH 13 2L 1_68 rev. 5M <. F SAN JOAQLiIN LOCAL HEALTH 'DISTRICT 8/7h 3M