76-845 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION ..... ....... ............................... FOR SANITATION PERMIT s :.........................."..:......."........._:_. . .. IComplehln Triplftate! Permit No. . �. ' :} : This Permit Expires f Year From Dole Itstred Date issued a:_SE 4 f - 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 complia a with Co u y Ordinance o. 549 and existing Rules and Regulations: .IOB ADDRESS/LOC ON ..rte®• __ .. .. . ... ...................... C mts TRACT ..................... Owner's Name - __::::.-.::.. ._Phone ... Address ------------ ---------- � � i - . •......�....�....�...... --•• : Contractor's Name .. -•----=-------, cense P :...... phie _ � - � Installation will serve: Residence CyA.partment House I] Commercial OTraller Court ❑ Motel ❑Other------------=--':....._..._. Number of Irvin units ...... Number of bedrooms , Garbage Grinder ' # 9 _.... Lot Size Water Supply: Public System and name -:. �. ............................. .�.'..... a.r ".......Private ------ ........................ Character of soil to a depth of feet: Sand❑. Silt❑ Clay 0 Peat❑ Sandy Loam ❑ Cay Dain Hardpan 0 Adobe j' Fill Material............if type...... -..... yes, I (Plot plan, showing size of lot, location of system" in relation to wells, bull Inch g 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 ' � ) i 3 . Size............................................... Liquid Depth ...._-------......-- ---�Y Capacity ----------E Type --•................. Material................. No. Com artments t p G Distance.to nearest:Well ,_.................................:.Foundation , ....................... Prop. Line ......__._.......__.-• LEACHING LINE ( j No. of Lines ........................ Length of each line..-,................... :::: Total Length . 'D' Box Type Filter Material ....Depth .Filter Material Distance to nearest: Well ............ Foundation Property line , .._-.."-"•....... ....................... SEEPAGE �T [ ) Depth ..............1---..... Diameter Number .............. .......... Rock Filled Yes [I No ❑� Water Table Depth -------Rock Size f, Distance to nearest: Well ....Foundation Prop. Line REPAIR/ADDITION 1Prev. Sanitation Permit _ Date Septic Tank (Specify Requirements) _'-_ - -.�-- ....:._ ..__ .:......:.:................. . •. ................. --•---...,...----....---- Disposal Field (Specify tRequirements) . .................. ....................... ••------ - - (Draw existing and required addition-on reverse sidel I hereby certify that I have prepared this application andtk f the work will be done In accordance with shin 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: "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 beta sublep�ct tot"41'4�4. kman's Compe sation law of California." Signed ------ U-�BY ----- ---- ----------•----------- _ Title : .- ---- .............. {If other than owner) ...---- -- ....•--... .. DEPARTMENT ISS NLY APPLICATION_ACCT PTEb SY --. =_ .� ":................._DATE. . :... .-_..� : BUILDING-PERMIT ISSUED -------------".-.....- DATE -.:....:-•-•••-•- ------ "-- -""---. ----------•-- --••-•--"------"••-• ITfONAL COMMENTS ..-. ,,....-.-.."-..... ...... ••--...............,------------ -------------- .... ...... ------------------ ............ Final Inspection by: -"-"---- .Date " = .......................... .... EH 13 2h 1-6I3 lieu. �I .. ..................".---.��...-- , SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M