75-705 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: .... ............................. /....... APPLICATION FOR SANITATION PIERMIT ....... ............... :.....- _ _ --- ICoffli lete'ii6 Triplicate) . . Permit N0. ..� .... ....... T Date issued ..e?wf�S... : mins Z Year snDah Issoed ' Application is hereby made to the San Joaquin local Health District for a permit to construct and install the work herein` described. This appiitp#Ea¢ is made ngoompliance with County Ordinance 'Na. 549 and existing Rules and Regulations, JOB ADDRESS/LOCATIO '��•t'1_. ...�fl,/., .tx!� tIDS TRACT ........ Owner's Name .... , ... ., .. .................. ! .. Address � /,;V..e�.-............. ........................ ............. ...... ....... .-....Phone ...................._..........-- - Contractor's Name ...�,�.•�!�-=' •�� ........................... ity ................. ......._...._..._.........._......... .... .............. .. License#;V41i UPhone > � . Installation will serve: Residence Apartment House E3 Commercial 13Trailer Court Motel Q Other:-- Number of living units,... .._.. Number of bedrooms ........Garbage Grinder rte... Cot size .. , Water Supply: Public System and name .: Character of soil to a depth of 3 feet: - Sand -SII .. .r- .............................'".........Private, . b t Q N Cloy .0 Peat Q Sandy Loom 0 Clay Loam Ig Hardpan d Adobe 0 b Fill Moterlot............if yes,typo.:...:......... ....:....... #Plot pian, showing size of 'lot, location of system In rolatlon'to wells; buildings, etc. must be placed on reverse side.) NEW INSTALLATIONs (No septic tank or seepage pit permitted if pyblie sewer is available within 200 feet,) r PACKAGE TREATMENT [ SEPTIC TAMC "� 1 � ki Size.. G..:�.... _ Liquid Depth ... . Capacity f _ _.. ype �ii �Aril � ' No. compartments . ............. . Distance.to nearest; Well .. .. .�.......:.......Foundation .�.f1...�...... .. Lime ...�-sfAz Prop. ..... LEACHING LINE No. of lines ... ... length of each line. .�.................... Total Length a_.�'4_........... 'D' Box Type Type .Filter Material le' Depth FEltei Material .............. #. Distanc to nearest: Well .,V...... .... Foundation Q�..._..-... Property Line ..✓�.............~ SEEPAGE PIT . [- �.. i9ep#h ._._...___••---..... Olgmeter ..........:..... Number .... Rock Filled yes C7 No . Water Table Depth ..................................................Roth Size Distance fo n arest6 Well-, .... ... _....._. . ...: ...fou-ndation.. .................. Prop. Line ...................--- -REPAIR/ADDITION(Prey. Sanitation Permit .:........ .....................Dat ..........................:. . Septic Tank (Specify Requirements}._.......... . ........... . . ......... ' Disposal Field (Specify Requlrements)- . ................ -:...._:.... �........... - r:..- -...: { (Draw.existing and required addition-on-reverse side) I hereby .certlN that), have prepared this application and that the work wilt be done in accordance with San ia�illn County Ordinances,-State Laws, and Rules and Regulations of the San Joaquin Local Heal&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 shol# not employ any person in such manner as to become svblecf to Workman's Compensation laws of California." Signed ............. - n ............2noWwnerJ* - Owner By - ' ..------_. title _. {If`oche`, , FOR IIAPARTMENT USE ONLY APPLICATION ACCEPTED EKY.----- ._. . ... ...................................._.-_.._.._.. ... ...._ -DATE.......1. -._ BUILDING PERMIT ISSUED -__--- DATE ............. ADDITIONAL COMMENTS ................................... .................... ............ ......-*-, .............................. -------------•- .................................... .................................... -••.......................................-- Final Inspection by • :w D ! �., .. EH 13 2h 1-6 H Ikv. 5M AN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M Date ... .. .. .