76-216 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (CoPermit No. mplete In Triplicate) . �: !:�.::. ... _.__. This Permit Expires 1 Year From Date Issued Date.Issued .................... 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 co ionce with Co my Ordinance No- 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION .. l .... :.,_..._. ,...CENSUS TRACT s ¢.:........ Owner's Name ...�� ?.:_. -rx�:¢1_... .......... ......................................:...:................Phone ... Address `^ -._...... City ..........0 3/z 762-1 Contractor's Name ....e!V a A4'.kQ'X-�.. .. c..-...--•----..L€cense # ............. Phone .............................. Installation will serve: Residencep Apartment House fl Commercial 13Trailer Court 0 Motet❑Other ..................... Number of living units:-...--/_- Number of bedrooms--I Garbalir Grinder Lot Size ................................. Water Supply: Public System and name .---,,,-•:.............................„___ �_ _... ..................,...................Private ❑ Character of soft to a depth of 3 feet: Sand E] Silt 0 Clay ❑ Peat❑ Sandy Loam ❑ Clay loam Q Hardpan❑ Adobe 0 Fill M6terlol ............If yes,type ............... ............ (Piot plan,. showing size of 'lot, location 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_........... ....................I............. Liquid Depth ...... .................. Capacity ....... No. Compartments -- ------------•--- Type ...:..:..--•-----... Material... .....:..... Distance to nearest: Well ............Foundation ... Prop. Line ...................... LEACHING LINE [ ] 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 PIT O Depth .................... Diameter ................ Number ..._„_ .................... Rock Filled Yes ❑ No C3P .. ' Water Table Depth Rock - Size ............................ . .Distance to nearest: Well ....... ...............................Foundation ............ Prop. tine ..................... REPAIR/ADDITION{Prev. Sanitation Permit ,____ --_-__ Date -------------- -- Septic Tank (Specify .Requirements).---- •--N ..-----••.----• - ......................:._....-- -----...... •-•---- Disposal Field ( pacify R quirementsr--- ...... xl�..... 7ee tl (Draw existing and required addition on reverse side) 1 hereby certify that I have prepared this application and that the work will be done in accordance with Son Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Htalfh;Dlstrlct. Home owner or licen- sed agents signature certifies the following: "I certify that In the pe rmance of the work for which this permit is issued, I shall not employ any person In such manner as to become e s '1 subject td orkm�n's Compafion laws of California.” Signed -- "� ` ........... /f� Owner By ..------ `- ff title -- _.... -- - ._. . _._... -•------- (if other than owner) FOR DEPARTMENT USE ONLY ` APPLICATION ACCEPTED BY ._�ie_ E� ��r . -- -------- ......................-- - DATE ..-��A BUILDINGPERMIT ISSUED _-----------•------.-- ........ -----------------....... -_-.----------______- ...........DATE -----•- -•-•-- .................. ADDITIONAL COMMENTS ................... ----------- ------------------------------ ---•-• _ .... .. ----------------------------- ...... Final Inspection b f.... Datg iii 13 2!t 1-68 Rev. 5m SAN JOA IN LOC HEALTH DISTRICT 8/7h 3M