77-428 - Laserfiche WebLink

Home Browse Search

......... ..........:................4............... APPLICATION FOR Swwr ORI PERMIT ....... . . .................. -.._....._ --lComplete in Tripllcate)f• .. . '"' Permit No,_7,7:. f k .......................................... This Permit Expires 1 Year Front Date issued Application is hereby made to the San Joaquin Lacal_Health District for a described. This application-is made-in compliance with County Ordinance No. 549 and exi�stinnRulestand Re ulthe o�oke cin JOB ADDRESSAOCA IO � .,�.��.-.�..�:� -� .: ...........,..., g g �~ .... ....CENSUS TRACT` .... ,. Owners Name 1C6tit,.. . Address ................. . .........................- . ......................................................Phone ' e ................City ........ ....................................................... Contractors Nam isidence ..._... .....License . r� Phoneinstallation will serve, W- partment House[] Commercial❑Trailer Court 3] Motel❑Other_::... .................. Number of living units,..._______ Number of bedrooms .....Garbage Grinder Lot Size Water Supply, Public System and name ............................---- .............................................. ...�._ . Character of soil t depth of f .. .. ..... .._.. .�. . .....................................Private a o a d p 3 feet. Sand❑ Slit❑ Clay Q Peat o Sandy loam ❑ day Hordpan.p •Adobe❑ FIII"Material ......_.....if yes, ........:.... loam ❑ ' !" (Plot plan, showing size of lot, location of-system in rejatlan to wells, buildings, etc. must be placed an reverse side NEIN INSTALLATION, jNo septic tank or seepage pit permitted if.public ':sewer Is available within 200'feet,) PACKAGE TREATMENT SEPTIC TANK( Size.....................:..._.-.................... Liquid Depth ..... Capacity L/ �� ..__..... ype -• �� - Material...................... No. Comp I... f Compartments ...-',.1.�........� Distance to nearest: Well ..... ... ..................•---.Foundatlan ..��.... ... Prap. tlno. ..:....... NG LINE Lines �,�- . LEACHING ( j No. of i b:---_-•-•-------. Length of each line"'A ..................... Total Length Type Fitter Material a -Depth filter Material _ _ • . Distance to nearest: Weii :.....-t�ndation ............ PropertyLyne ..............:. ...::" i _. -` _. ... SEEP- G.� E j Depth ----..: ...--- . Diameter ................ Number _...,.........----.......... hock Filled Yeii .. 'p No C3 � Water Table Depth .......Rock Size Distance to nearest: Well...:.................. .......Foundation ...........::....:: Prop. (.ins:_._.._... + REPAIR/ADDITION(Prey. Sanitation Permit __ _ ��.._. ....-- Date• ..� Septic Tank (Specify Requirements) .............................................=`........ .......................... .�- Disposal -Field (SpeciW Requirements) .................. ----.... ... ..........._......Y. ....... -------•--•y......_•••-•-----•..................•-••------••-_.. ...................................................._._............................................... ....................... t ------- .............•......................................................... ...__.................._.................................. ....................... .... ........'..._.. -- (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work wilt be done in accordance with San aquln 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: r "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 C mpensatlon laws of California." r e Signed ....... ......... Owner y ...... ..............................:..................... ---- -•--........ yitle .......... .........................(If other than owner . . ....... •............ o FOR DEPARTME USi: ONLY ' APPLICATION ACCEPTED BY ..... D,ATE...... .: ., :.: BUILDING PERMIT ISSUED DATE ...................:...............:....... ADDITIONAL COMMENTS ........ ............ .......................................................•--...........................-------- ........................I——...... ....................... ......-•--•.......................................... ............. .............. ....... final Inspection by: ................................................ ....- ......... ..........................•.......Ddte EH 13 24 1-611 v. { � SAN JOAQUIN LOCAL HEALTH DISTRICT 8/711 3H ; _ _ 1