76-948 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ;Complete in Triplicates Permit No. . ...5. � ............................................... ---•-•.....................,..............-.............. This Permit Expires 1 Year from Dal*Issued Date Issued Z<�..P:.......0 Application is hereby made to the San Joaquin Local Health District for a permit to construct and Install the worts herein described. This application Is made in com tioncet with County Ordinance No. 5:49 and existing Rules and Regulations: _: JOB ADDRESS/L ATIO �.t I.> ► _.. .:v m— .... .....CENSUS TRACT .. Owner's Name,' ..... ...Phone Address Z.6G b-... U)...... �u- 1StY. .... -I-----------•----•-,. City ...-�.��C.i� Contractor's Name ......I--. -------•------•...................................License# ......................... Phone ---........................... Installation will serve: Residence 0 Apartment House f3 Commercial OTralter Court 0 Motel []Ctther- _ . Number of living units------------- Number of bedrooms ....t.-----Garbage Grinder ............ tot Size ..........-...............:................Il Water Supply: Public System and name ............ . .. _ _—-------_-----------------------...................Private❑ ]� Character of soil to a depth of 3 feet. Sand'j] Silt 0 Clay PeatC] Sandy Loom[] Clay Loam 0 Hardpan 0 Adobe C} l Material ............ If yes,type............... ............ .i {Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.} NEW INSTALLATION: INo septic tank or seepage pit permitted If public sewer Is available within 200 feet,s PACKAGE TREATMENT I ] SEPTIC TANK ] Size........,.......... ... -.._..-- ui q Depth ........................... . -................ Li Capacity P—Q....... Type ��1� �Illaterial...................... No. mis artments �-� Distance to nearest: Well ---Zahn...................Foundation /0------------ Prop. Line .. ...... ..� Length of each t€ne-.� �y LEACHING LINE ) No. of Lines ---• -.-_.--- g ._----. Total Length - SJ.._.... ' �r 'D' Box ......-.--.. Type Filter Material ..1 �(J'CIf�Depth I=i ter Material _._.. . .......................y. Distance to nearest; Well. / P....... Foundation �A .-....:_.I.... Property Line . SEEPAGE PIT [ l Depth -------------------- Diameter ..............__ Number ........--.-_ .............. Rock Filled Yes CJ No Water Table Depth -•-•----••..............•-----,..-------•----...Rack Size ................................ Distance to nearest: Well ........................................Foundation ......... .......... Prop. Line ...................... REPAIR/ADDITION IPrev. Sanitation Permit# ............................................. Date ................. ................ Septic Tank (Specify Requirements] .......................-t................................ .......................................................--...................... Disposal Field (Specify Requirements .. ............................................. --- ---- ------- -- - -- --- (Draw ex!sting and required add#tion on reverse sides I hereby certify that I have prepared this application and that the work will be done In accordance with San Joa In County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local Health,District. Home owner or If sed agents signature certifies the f ing: "I certify that In the performance f the work for'which this permit Is Issued, I shall not employ any person in such manner as to bine ublect t We an am so ' laws of California." Signed ..... .. .. . ....... .... - --------- - . ................................... Owner BY -- --- -------•- Title _....... (If other than owners R Dl:P TME USE ONLY ' APPLICATION ACCEPTED BY ------ - - ----- - --- .--- DATE .. ..------- ...."-7. -- BUILDING PERMIT ISSUED -------------------- - -•-----------------------•----- DATIr i ADDITIONAL COMMENTS ................................................................ .......... = .•.............. ----•----- -•----- ---------•----------------------------........ -------------- ................... ..............-------------------------I'll......... •------------ ---------------------------------- -- - ............... Final Inspection by: --•------------ ----- ....Date ... EH 13 24 `6 i v` SAN JOAQUIN LOCAL HEALTH DISTRICT � 8711 3M i