72-354 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: " APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. --------I--------- ------------------------------------ ---------------------------------"---------------- This Permit Expires 1 Year From Date Issued Date Issued 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 County Ordinance No. 549'and existing Rules and Regulations: . JOB ADDRESS/LOCA ION __-___ �.NE�--"..A:VCENSUS TRACT Owner's Name °----------- ------ ------ ---Phone+`?'-I O- _/._.... ------- C� .A Address r ! - 7 n�--------/----__A"YE__. City ---'� �� C� (_�1 --------0A,------------- Contractor's N ----- /p1 �$ ------------- QIV S-- -------.License # Ior�.T V------ Phone4_66 by?_ Installation will serve: Residence 4partment,House-❑ Commercial :❑Trailer Court ;❑ r Motel D,OtherI------------------------------------------- Number ------------------------------- --- - - -Number of living unite""" "-- Number of, bedrooms _�-_--_Garbage GrinderA/.0__ Lot Size 6-aX---/-_ZS7----_--__-_ .� 1 Water Supply: Public System and name _______' ___.___ --------------------------------------Private ❑ Character of soil to a�depth of 3'fe6t:*4Sand"'❑' S t'❑ ',Clay .❑ �Peat 0' k Sandy Loam ❑ Clay Loam ❑ J. n Hardpan ❑ Adobe Fill Material -------_.-- If yes, type ---------------------------- (Plot Ian, showing �' # s 4 M I p g�size�of lot,�location of system in wells, buildings-, 64c. must be placed on reverse side.) W NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT i [ � tiSEPTICTANK;K � Size-�--�--��-�'-------""_"-- Liquid Depth�� '._.....,_-_-- t 1"&pacitf y�� _-_--_ TypeiP� �Material_0No.I Compartments _ _.".............. Distance. to nearest.- Well,W-0-M-1,5 --------- J'0--; ------- Prop. Line _1 ." �. LEACHING LINE No. of Linesi.(I-T-- Length of each line-gQ,-."--"."-".."-.__ Total Length ,_��---..-_--..-_"_- D' Box',C�-".` --- Type Filter Material ' " CI "Depth Filter Material _-I__ ----------------------�_--- Distance to near st,"Well'NOME-__------- Foundation - ---" Property Line -_IO--"-"......"_ SEEPAGE PIT Depth ------"- Diameter _"_____ Number . "-- Rock Filled Yes, No 0 A / r l r Water Tabl6tDeptFi _ (7Q;--------------------------------Rock Size.--Imo--X:fZ--�-- Distance to nearest: Well """" Prop. Line _ "-4!_"__"_".__"__ REPAIR/ADDITION(Prev. Sanitation Permi## -------------------------------------------- Date' --- ------.---_---_-----_) Septic Tank {Specify Requirements,) ` �� __%-) ----� --------------------------- sposaf Field {Specify Requirements) ----- _-- -_-- ____ --------------------------------- ------------------------------------- - ----------------------- --------- --- -- - ` ---------- (Draw existing and required add! on 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 Laws, and Rules and Regulations of the. San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: , "I certify tha erforma a of the work for which this permit is issued, I shall not employ any person in such manner as to beco arubiect t 1iVor n's Cmpe n r laws of California." SigTSe -- ---- --- Owne --- ---- --- ------- - - - t---- B Title (If other than owner) = FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY 'r a 1 = DATE iv BUILDING PERMIT ISSUED ------------------------------ ------------------------------------------------------------------DATE -------------------------------- - -------- ADDITIONAL COMMENTS ------------------------------------------------------------------------------ ` = i ------------------------------------------------------------------------ - ------------------------------------------------------------ ------------------------------------- --------- _ ------- ----------------------------------------------- - -- - - ---- ----- ------------------- - - - - Final Inspection by: ----- ----- '' Date --- G� [�' --- -----------------------------. k SAN JOAAQQtAN LOCAL HEALTH DISTRICT I E. H. 9 1-'68 Rev. 5M