71-857 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: : APPLICATION FOR SANITATION PERMIT I yl- I Permit No: _7_./-15-7 (Complete in Triplicate) ----------------------------- r --- - ----- q _. r- -------------__- _-J:-.___--.-�, --_ This Permit Expires 1 Year From Date Issued Date Issued __-(-'_� ___ � ®q3-lea -03 Application is hereby made to the San Joaquin Local Health District for a permit,to construct and install the work herein described.-:This-oppl.ication4is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: �k`-em-;?� �±I'►1C- ;; „f��/� , 1 JOB ADDRESS/L CA ION t- -- � -' -------------------------------CENSUS TRACT ---------------_--•----- ... h ` Owner's Nam -h-`2 r-Mr-L-A-- —---------------------------------------------------Phone... 40' Address ------------------- = Cit ------------- --------------------------------------------._......_ Contracto.r's Name-�.�:<q_��._�c`_��____�_��_�►-�__��_��___-License # _*4C�'___ Phone ._1i7) .!7240.�P Installation will serve: 'Residence Z Apartment House❑ Commercial❑Trailer Court '❑ Motel ❑Other -------------------------------------------- Number of living units:---_l-t___4Number of bedrooms _3------Garbage Grinder __Y 0_ Lot Size ------- h� - ' Water Supply: Public System and name --------- __ Private x Character of soil to a depthlMof 3 feet: OSand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam [] Hardpan ❑ Adobe �(' AFill 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: IN' septic tank or seepage pit permitted if public sewer is available within 200 feet,) N /, PACKAGE TREATMENT [ �� SEPTIC TANK Size________Xr%2__ ____ Liquid Depth ____f-ap____`,_.__. Capacity / e0____ Type �__________ Material_ �__ No. Compartments ..__. ........... Distance to nearest: Well --------.�0--r--- _.__Foundation _---7- ___-_____ Prop. Line ----3 An?..... ._- LEACHING LINE ( No. of Lines --------�---------- Length of each line------ ------ Total Length ,______Zee......... Of ro QMM ___--_-I` Box __ Type Filter Material -----2- ---------Depth Filter Material _____ _ ______________I............. .._ E I r Distance to nearest: Well _._,,�Q_�________ Foundation _-,.��_f_________ Property Line ----- ....... SEEPAGE PIT [)Q Delpth ---- �/-___ Diameter --- -� Number ---_�_--__--____ Rock Filled Yes j?r No 'l I . Water Table Depth --------------�-----------�--------- --------Rock Size ---- '� ---- - ---------•---- I - Disltance to nearest: Well ------/47(?----------------------Foundafiion _--_ f------ Prop. Line .._Z;.sP---____-_. REPAIR/ADDITION(Prev. Sanitation Permit# --------------I.O-----------_--____------ Date ________-____--.-._._____-____--__) Septic Tank (Specify Requirements) ` Disposal Field (Specify Requirements) ------------ y_!_�---5��------''Q- -- ------------------------------------------------- --------------- --------------------------------- I ------------------------- ----------------------------------------------------------------------------------------------- ------------------------ .I� --------------------------=-------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------- (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 County Ordinances, State Llaws,-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 California," r I� - ' Signed --------------------- ----- ---------------------------- -1----------------------- Owner _ I BY --------------------------------------------------------------- ' ---------------------------- - - - ---------------- Title ------------------ --- ----------- (If other than'lowner) IM FOR DEPARTMENT USE ONLY IAPPLICATION ACCEPTED BY mow. - DATE -i--------------------------------- BUILDING � 4--•----------------- - w BUILDING PERMIT ISSUED ;I - ------------------------------- ------------- DATE ADDITIONAL COMMENTS .1--- --------- _-- -------------------- ------ --------- f - - -----------M----- �- -- --c� ---� -------------------=- � ----------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------- -------------------------- ----------------------------------- i G Final Inspection by � ----- -----------------------------------------Date ----�` 7- -- ------------ SAN JOAQUIN LOCAL HEALTH DISTRICT E. H..9 3 , 1-'68 Rev. 5M