78-366 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: 1410 APPLICATION FOR SANITATION PERMIT ..................V...__................---._ No. .. (Complete In Triplicate) Permit ................... V =/ 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 compliance with C unty O dinance No. 5549 and existing Rules and Regulations: JOB ADDRESS/LOCATION 7�.- -4 k ................Ga ............CENSUS TRACT a. ... Owner's Name ------9-"4)- -- -------- .... _. ..Phone .731-10 X...-. Address . AP, . .... .....City ...... ............. Contractor's Name .fir ....License #aP;7Z J,.... Phone Installation will serve: Residence❑Apartment House f7l Commercial QTrailer Court 0 Motel ❑Other Number of living units_____________ Number of bedrooms ............Garbage Grinder ............ Lot Size ...�...•....... Water Supply: Public System and name --------------------------------------------.....................................................PrivateX Character of soil ton depth of 3 feet: Sand o Sift o Clay ❑ Peot❑ Sandy Loam tj -Clay-Loam❑ Hardpan'r Adobe ❑ Fill Material ............ If yes,type ............... .... � �_ I 1�1�11 i IRR'llilll�II�I�� (Plot 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................................................ Liquid Depth ..............._... ......N Capacity ---•--- ------•-- Type -------------------- Material---------------------- No. Compartments ...................... %�j Distance to nearest: Well ....__._Foundation ...................... Prop. Line ...................... 11-1 LEACHING LINE [ ] No. of Lines ........................ Length of each line............................. Total Length LA 'D' Box ..---------- Type Filter Material ....................Depth Filter Material ........................ ................... Distance to nearest: Well ------------------------ Foundation ........................ Property Line ....................... SEEPAGE PIT [ ] Depth .................... Diameter ................ Number -------------- ------------- Rock Filled Yes ❑ No ❑ WaterTable Depth ................................................Rock Size ................................ Distance to nearest: Well ........................................Foundation .................... Prop. Line ...................... REPAIR/ADDITION{Prey. Sanitation Permit# --- - --- --------------------------- Date --••. •. ---•--- � Septic Tank (Specify Requirements) --•------ ------ ..c........................._..... ............F.......... Disp sa! Fie d {Specify R uirements) ... __ ._ ._ ._._ ....- --- .... ..- (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work will be done In accordance with San 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, 1 shall not employ any person in such manner as to be ubje to Wofr : n's Co en .ion laws of California." Signed __ �/ r ,.. Owner By -------------------------------------- --- Title ----------- ----------------------------------------------------- (if other than o �er ,FOR PEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------ ------------------------ -------- DATE ..... . .. .. ----._...------- BUILDING PERMIT ISSUED ----------------- DATE .------ ----------------------------- ------..----- ....__..-..._.. ADDITIONALCOMMENTS ---- ----•----•--- .................................................... .......:..- ..........-........ ..--------------------------- Final inspection by: ........._ ........................ ......Date .. . . .._.........--- ---- 13 � "� Rev. AN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M