74-742 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: j APPLICATION FOR SANITATION PERMIT ...................... .............................. Permit No. (Complete in Triplicate) ................................................ This Permit Expires I Year From Date Issued Date Issued . -. .:7y Application is hereby made to the Safi baquin.L`ocal Health District for a permit to construct and install the work herein described. This application is made in complianciAvrth County"Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATIO ...,.JP1 . ..... .._..:_................ .......CENSUS TRACT .:.....:.:...:.::...:....: Owner's Name .... _ . . ............•...... ........ .... Phone ..... Address ................................ .Z ..... .. . !? `'Cifiy` .......� .. .. ... Contractor's Name ' _ .: ] �-.1... ? ,, . --- ...... ..... ... .. s ?` i icense # � . -•- ` Phone Installation will serve: Residence Apartment House❑ Commercial OTrailer C6urt 0 � . Mote Other ...................................... ..._.. 9 / 9 -_. __ Lot Sizrre...�j_'10. �C Number of living units:.... ....... Number of.bedrooms __.._ .__..Gdrba a Grinder. ... .. ...�1.-.�.............. , Water Supply: Public System and name . � ... �-. ............. .Private ❑ i Character of soil to a depth of 3 feet: Sand❑! .Silt❑ Clay�kEJ Peat❑Sandy Loam ❑ Clay Loam ❑ Hord an Adobe Fill M Iter, i . ._ . p ❑ a. ,a If yes,type (Plot plan, showing size of lot, location of system Gin)relation to�'wells, I;ui dings, etc. muttt! placed on reverse side.) `1-_4 t i NEW INSTALLATION: (No septic tank or„seepage, ed if public-sewer is available within 200 feet,) i Liquid t PACKAGE TREATMENT [ ) SEPTIC TANK I�]� Size................................................ Liquid bepth .......................... ' Capacity ' P tY Type '............... Material......._......_... No. Comprtments .._...V Distance to nearest: Well .............................f_.•__Foundation .................. Prop. Line ...................... LEACHING LINE [ ] No. of Lines ........................ Length of each line..._________.__...._.._._.. Total'—Length ............................jA I 'D' Box .... ....... Type Filter Material •............ ......Depth” Filter Material ....-......._............._.............. Distance to nearest. Well ........................ Foundation ..................... .. Prop 4 Line ....................... jSEEPAGE PIT ( j Depth ---------- Diameter Diameter ................ Number ..................:...... _ Ro&Filled Yes ❑ No Q ( y 1a . 1 • Water Table Dept-fig, '� ..:.............. .....Rock Size ----..1..._._..1._ Distance to nearest: Weil,:._.....__ :................ .....Foundation .... ..... Prop. Line ...................... REPAIR/ADDITION(Prey. Sanitation'Permitt# -------�................. .. Date :i................I Septic Tank (Specify Requirements) --------------- ..... ---- 5�.:..... Disposal Field (Specify Requirements .- - ...x../...... _ ---.. f. ...... - ----- ------------------ -------- ..._... ................ ------` --------- ................•••-...•• ........................................I-----------•---------- (Draw existing and required addition on reverse side( i 1 hereby certify that I have prepared this app!€cation and their the••work—will-be-Fdono-in--accorda nce with San Joaquin County Ordinances, State Laws, and Rules and Regulations of fhe San Joaquin Local-Health District. Home owner or liten. sed agents signature certifies the following: i "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person In such manner as to become subject to Workman's Compensation laws of California." Signed ............ ............... ... r --- Owner By .......----- •• ................................... Title ;. :.................................... i (If othe tan owner] FO DEPARTMENT .LISE,,ONLY:\ 1 ,•, ; ` t,'. DATE ... - `'�. APPLICATION ACCEPTED BY .... f - .. 4 1 BUILDINGPERMIT ISSUED _................. ....�.. •----------..._•...................................._..............DATE ......................................... ADDITIONALCOMMENTS .......... ........ ............... •-----•-•-----------•---...-------..................... ...........:........................... ........................................... ......•--...--------.._...--•--- •--•-.._.t- . ........................................................•........................... _ --------------•-----------..-...........-• -- = ...:........._ ..__....... ,- Final Inspection byDate __ i SAN JOAQUIN LOCAL HEALTH DISTRICT { E. H.13 241-'68 Rev_ SM 71723-M