74-47 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ': APPLICATION FOR SANITATION PERMIT {Complete in Triplicate) Permit No. ... .�`.:.7`1.,. .................................... .......... ...I�.---. This Permit Expires T !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 mode in compliance with County' Ordinance No. 544 and existing Rules and Regulations. J JOB ADDRESS%LOCATION��._...._/7.�-� c�Q -c,c� CENSUS SAA TRACT Owner's Name .........- 4.:. x"1 . .-•----•-• ._......- ....-I_-......--...Phone Address � ......... . .. -------- city - . ' . .----------- Contractor'slicesne # / j5 .....................................11�� Nomeone I Installation will serve: 11 Residence Apartment House❑ Commercial-oTrailer Court ❑ V,J, otef(-OtherNumber of livin units:.. Number of bedrooms ..- ) 3`' 2 j Y.-.-Garboge Grinder - -.-.... Lot Size ...- r Water Supply: P blic System and name ---------------- •- 'r� .'ti •s..- - Private ❑ w -- Character of soil fo a depth'of 3 feet: Sand Silt❑ Clay a❑ Peat(] Sandy�L am 0 Clay Loam ❑ i � i �y i Hardpan ❑ Adobe ❑ Fill Material -1-_...•-•-- If yes, type ............. ...... (Plot -- _ z I (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,) i Capacity . T e Size.-- .. F� .................... Liquid Depth ----------------- ........ PACKAGE TREATMENT SEPTIC TANK Yp .--iMatenal -.---_-- No. Compartments ...............J D'istonce to nearest: Well------------------------Foundation . .--.......-...- Prop. Line ................ LEACHING LINE [ ) Na! of Lines . .. ... . L 11 ength of each line Total Length Distance to nearest. Filter Material .-------.._______"Depth Filter Material ..................... .................... D', I l8nc -t Type ll - -.-. l ........ ----• Foundation ............. ...... Property Line - SEEPAGE PIT De ��th ... # �— C (' Water Table De t.. Dia! eter �.,�Number A-.-....- !-..--._- Rack Filled Yes ❑ No C] p -----------Rock Size ...-7-----....4-41...... -_-.- r- Di�st�nce tinea si: Well .. . ---_ Foundation --- Prop. Line ---------------------- 0 ## � . . REPAIR/ADDITION(Prev. Sanitation Permit# -------1 - ..... _...- -_ __-_- _ -- Date .....------. ........---- ) Septic Tank (Specify Requirements} ........ .- ..- ..�.... _ -.. -lg .;r - ' ..... �..�_.'...- _ ... k --------'.-e-l—..f.![.{ •......... ....................... Disposal Field (5pecif m 'a ------------------- ----------- - -- - .�.. t..-.. ��...-.........-- ---------- ---- :_::_ ' (Draw existing and required addition on reverse side) { I hereby certify that I haire.prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, Statel.Laws, and Rules and Re4ult3tions of the San Joaquin Local Health District. Nome owner or licen- sed agents signature.certifies.the.following: I �. .1 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 .... ............. ......... �t-----•--- ---------- Owner 8y ......... Title (If other n O -........ wnerl D ARTMENT USE ONLY APPLICATION ACCEPTED BYE....... DATE ...I. . . .a. ..... . ....... ........ -------- T:.._. -.. BUILDING PERMIT ISSUED ..1i --- - ----------------------- - - -----------DAE ADDITIONAL COMMENTS ...'(..- -. �i ------------ ------------ -------------- •--•----- 7.... ---- ---- -------------- ------- ........ .--------•-•-.--.................... ...... •---- ..........................---------- .... Final Inspection by: .. > _. Gam/ - Date . //- --. if 7�.--.. SAN JOA. IN LOCAL HEALTH DISTRICT i . E. H.-13 241-'68 Rev. 5M II