76-708 - Laserfiche WebLink

Home Browse Search

y. FOR OFFICE USE: APPLICATION. FOR SANITATION PERMIT .......................................... r s� ;Complete In Triplicate) Per mit No _..7 �61P .-.._...... _._._ .,...� Dat Issued .. This Permit Expires ] Year From Date Issued e fss 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: ` / � �4� JOB ADDRESS/LOCATION k .........CENSUS TRACT ! b Owner's Name ..._ ...... hone - - ...-.._.. _ ............................... ....••................- .. ....._...-......Address ��... 1 City . ^; t. ..................... Contractor's Name ---- -- ---- -------------o !`J--...License #/ Phone ....................... Installation will serve: i Residence[-Apartment House f] Commercial❑Trailer Court ❑ Motel ❑Other..............................I............. s I Number of living units--.j�__:-_-Number ofbedrooms.-. ...._Garbage Grinder ...._._. ... Lot-Size .......-•--- -�:-.......... � Water Supply: Public System diid game ..... ........... . . ..............._....-........... ....................... Character of soil to a�depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam 0 Clay Loam E — r Hardpan C7. Adobe 0 Fill Material If yes,type i (Plot plan, showing size of lot, locations 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,) PACKAGE'TREATMENT ( ] SEPTIC TANK } Size________________________________________________ Liquid Depth .......................:.. � F Ca acl ------------------- Type Material_____________________ No. Compartments ............... Distance to nearest: Well ...... ............................Foundation ..- .................. Prop: Line ..................... LEACHING LINE [ j No. of Lines ..---•-------- -=------- Length of each line-------------._.._x_._..... Total Length ...................... 'D' Box ..---------- Type Filter Material _...................Depth Filter Material ........--•................................•_ Distance to nearest: Well ------------------------ Foundation ............_......,-... Property Line .....-- SEEPAGE PITp [I No �] De th .................... Diameter ---------------- Number --------------=-=----...._-. Rock Filled Yes Water Table Depth ------------------------•------•- --------------Rock Size -...'.:r..'..................... Distance to nearest: Well ................................ ` .Foundation .......... ... Prop. Line REPAIR/ADDITION(Prev. Sanitation Permit# _--,-_---•---------------------------- _. Date _____ ......... i SepticTank (Specify Requlrements) ------------ ------------------ ---........... ------------.. ...... ...............................-..................................... D' pos Field (Specify Requirements)�Q 1: - ---- - ---------`- ----- - P�---.� - -- a --Q � - ------- .......-----. h -•---...----•• -•--- ................................ (Draw ex ting and req red addition 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. Hone 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 ompley any person in such manner as to become subject to Workman's Compensation laws of California." ' Signed ------------ .....................•-•------------ Owner BY ----- ----------------- `G� '� t `l-�` ...•• Title ..__. (If other than owner) FOR,43EPARTMENT USE ONLY APPLICATION ACCEPTED BY ....... _ 1 BUILDING PERMIT ISSUED ------------- --------------- ----•-•--:................ ---•---- -------------- ............... ........DATE -..-_-_-.------•------_ ----------- ADDITIONAL COMMENTS -------• ...............•------..... - _... ---------- ------------------ ---- - i Date - ---•,*.......- >45... ....- --------------- --•------ ------- -•-•-•-•------- ......- • -..... ------ Final Inspection by: .. -_._...fid. 4 _..-._.--•-•-•-----------------------------•-- -.. e Eli 13 2h 1-68 R.-ov• 5M SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3M