76-278 - Laserfiche WebLink

Home Browse Search

J APPL]CAT]ON OR SAN]TATION pIERMI'l; ,FOR OFFICE USE: Permit No. . .- ....-- --... (Complete in Triplicate) �j_7L .....--.... . ••' Date Issued •��•• .. ...... ........... """""•--'---•-� This Permit expires 1 Year From Data issued -•••••••-�•---'-""-"�• permit to construct and install the work herein Application is hereby made to the San Joaquin'Local Health District for p application is made in compliance with County Ordinance No. 5d9 and existing Rules and Rego at�ons: described. This app T ....RDI ......... L--....�---•----------------_._............CENSUS RA TION JOB ADDRESS/LOCA �.7 .:__... -..Phone �7 ... r..:- --- .....�' .t1 .. ..:. 9.._.1. . .. ....... Owner's Name :.... City .-J��-�-�`.......................... - b. Phone Address .......:...... � �Z� Y..._.License # --•-- ._....... Contractor's Name ......-�� artment House❑ Commercial ❑Trailer Court Installation will serve: Residence AP �. Motel C]Other . F� lot Size ....-..--�•-....---•---------.............. Number of living units:......-(_ Number of bedrooms ... --Garbage Grinder .- r-• s Priva ❑ C L- f3 �L— .. -------------- .-.._----_ . Private y � Clay Loam ❑ Water Supply: Public System and name ..............�••----••�• . Peat Sand Loam Character of soil #a a depth of 3 feet: . Sand❑ Silt❑ Clay ❑ ❑ e�........................... i Hardpan ❑ Adob .❑ Fill Material --VD...• if yes,typ E buildings, etc. mu t be placed on reverse side. {plot plan, showing size of lot, location °see sem in epage p's r lotio rm ttedof public sewer is available within 200 feet,] d��F No septic tank p g NEW INSTALLATION: ( " aLiquidDepth ''='R Ii � Siae... PACKAGE TREATMENT. [] rSrPTICTANK�[a-� � •----•-:-M..,a.�t.e..r_i�a..l:.�.....�.�........�...•-..-,---�-•� N---o- Compartmentsartments ......... ............ _J Capacity ... ........... - TYPE - - •------ > . Prop. Line ..Foundation "...................• VI . Well ...-_...--- -. Distance #o nearest g - otal length ............ . No. of Lines .-- L n th of each line LINE [ ] Depth Filter Mate ial ..............•--... -� 'D' Box ............ Type Filter Material ._... - Property Line --•----• •--• •••-:....Q' -�' Foundation ............... .. " . Distance to nearest: Well ........................ {tock Filled Yes ❑ No C Depth - Diameter'�__...-Number ...-•--•--•-... .......... SEEPAGE PIT [�) p t th. -- -- ...... ..................Roc Water Tahle._TDe P ------ •- Prop. Line •---••-1 - .............................Foundation _.. Distance to,nearest: Well••••--• ' ._. Date Prev. Sanitation Permit# ••-•-•------- . REPAIR/ADDITION( -"•"----•--•-•- Se tic Tank (Specify Requirements) ................. ......... !f ll ddC � _.N. . ..................... Disposal Field (Specify Requirements) ...-_--•-• _ s'r ..�-------------••-•-•-----.......................--......._..-..-._......--.........-.-... — ........................... .• i •(Draw existing and required addition on reverse s+ e 1 hereby certify that l 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: ` erson in such manner "I certify that in the performance of the work for which this permit is issued, l 'shall not employ any p as to become subject to Workman's Compensation laws-of California-",Z ...... taner .........Y Signed ... ....... ... By ..-...__.. - - -- i (If other than owner)-A f FOR DEPARTMENT USE ONLY DAT APPLICATION ACCEPTED BY _- ------- ------'----- _-._ ..-•---..DATE ...-•._...---.............-,...... BUILDING PERMIT ISSUED :. •-- • ...... . .. .......... _.. --•-- -...._...•--•- ADDITION L COMMENTS ------ -•-- ......•-•------- ------- ---- -= .. ------ -- ......•......-..-......... 111� _ :_ i _ ::.. :.:- - _ _ �.. __ ..-...._ `...... ....... Date .: • F - Final Inspecti -- •---• -' - - - .• -. -- SAN JOAQUIN LOCAL HEALTH DISTRICT 7/723.K� , � 9A , C..