71-530 - Laserfiche WebLink

Home Browse Search

or FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT j (Complete in Triplicate) Permit No:�/'!_ ---- --------------------------------------------------- __________________________________________ This Permit Expires 1 Year From Date Issued Date Issued __"777/-. Application is hereby made to the San Joaquin Local Health bistrict for a permit to construct and install the work herein described. This application ismadein compliance with County'"Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION . --------W---a-KIE------------ ---------------- --- ----- - ------ --- .`CENSUS TRACT------a----------------------------------------- - -------------------- Owner's Name M l�S-----A IWIL.1-O-k0V-------C'_k)'ii'-r -A- Phone Address 7-1.5--------�=t9.-1-4.--KI-6--- ------Sf-� -- - --- -- - -- -- -------•.city ----=---`------------- - ---- ---------------------------------------- - Contractor's Name 4!�--------- ---------- ---------------------------------------------------.License# -------- -------------- Phone ------------------------------ . t .Installation will serve: Residence 2SApartment House❑ Commercial ❑Trailer Court ;❑ Motel ❑ Other Number of living units:---I-------- Number of bedrooms ___F *:_ -Garbage Grinder .-/V!P-- Lot Size ------ 0!?VOZ7____________________ Water Supply: Public System and name Z_/°F_L----WA-UM-"--------------------------------------------------------------------------Private ❑ Character of soil to a depth of 3 feet: Sand'E] Silt❑ Clay ❑ Peat❑ Sandy Loam •❑ Clay Loam ❑ Hardpan ❑ Adobe 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,) k PACKAGE TREATMENT [ ] SEPTICTANKf0. Size __L?+ _ _:___° Liquid Depth 45t ______ V t CapacityQf�Q_______,__ Type Compartments Material___ No. Com P o ••. .--•- j Distance to nearest: Well .11-744 P _ ______ _________Foundation .___/_U.___________ Prop. Line -- .... LEACHING LINE b4 No. of Lines ------I---------------- Length' of each line_-----7U---- --- Total Length J-Ly -.----_--.._.._ �. 'D' Box /VD__:__ Type Filter-Material 5_4 _ _-- __ Depth Filter Material __, ,________________________________ r l f Distance to nearest: Well ---IRAYt4.-------- FoundationlO_______ Property Line __._._-___ X Numbe- .________-_.---_,_----- Rock Filled Yes X No IQ SEEPAGE PIT pCJ Depth __�__________ ____ Diameter __ -______-_____ Water Table Depth 490 --------------------------`_----------Rock Size --- •f�+'w�_ � � t . Distance to nearest: Well ----------------------------- ----------Foundation ---------------.---- Prop. Line -.-.--------------_.-- I REPAIR/ADDITION(Prev. Sanitation Permit# ______________________________f___--±-__- Date :-: ______---__- _____________) Septic Tank (Specify Requirements) ----`---- ----------------------------------------------------------------------------------------------------------- Disposal Field (Specify Requirements) ------------ ------------------------------------------------------------- --------------- ' --------------------------------------------------- ------------------------ I (Draw ng and ! herebycert; that I have prepared this cation and required ad -- - --- ----- - - dition on reverse side) certify p p pp a 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 California." ; _ Signed --------------- - - ------ ---- - ----------------------- -"-- �--------- --Owner ,t �^ 1 By ----A- --- ------ ' _ ------ ---------- -------- ------------- Title --------------------------- - ------------------------------------------ (lf other than owner)! - 4 FOR DEPARTMENT VSE ONLY APPLICATION ACCEPTED BY j -- ------------ - ------------------------- DATE -6z!"�/--------------- =-------- BUILDING PERMIT ISSUED '_ DATE -- - ----- ------ ---------------- AD D I TIONAL COMMENT ------------ - ----- rL.D- ----- ------ --------------- ----------------- ----- _ -- ------ 6 Final Inspection by: _ ---------- --------------------- DateO/"]� -- -- --- --- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'6B Rev. SM