77-9 - Laserfiche WebLink

Home Browse Search

{ FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT I Permit No. ..7�: -•--• ............................................. ................ (Complete in Triplicate Date issued 1 This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin local Health District for a permit to construct and install the work herein i described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: CT _..._.................... JOB ADDRESS/LOCAT ON � � J"r ................. .-- -----ti,�•~:-- .. ........ . . .. ... CENSUS TRA .._..._.- . Owner's Name . .. . . ........�.- _.-...._ ._ ..------ Address ... ..: ------- ------- ----- City ...__....o .... .... _ Contractor's Name � _<d�l v�u'e'.License # �� _ Phone .......................... Installation will serve: Residence FJApartment House[I Commercial []Trailer Court ❑ Motel ❑Other ... -------�----------- Number of living units:............ Number of bedrooms -...--------Garbage Grinder ............ Lot Size ....-------------------------..__...__... Water Supply: Public System and name _--�J ? ----- ...------•..............-Private ❑ 1i Character of soil to a depth of 3 feet: Sand 71 Silt❑ Clay ❑ Peat❑ Sandy Loam L1Clay Loam ❑ w� Hardpan ❑ Adobe ❑l' Fill Material _._.-,...— If yes,type ----------- -------------- - k (Plot plan, showing size of. lot, location-of system in relation to wells, buildings, etc. must be placed on reverse side.) r fF NEW INSTALLATION: (No septic se p �ge pit permitted�if�public sewer is av-ailable within 200 f eet, ETX '7 Liquid Depth . ----7--.-•-•• PACKAGE IC TANK MateriaE_ '�? -. - No. Compartments ments ...... ..7....Capacit) Type U.�a, Distance to nearest: Well . ....i_ a._. ---------------Foundation ........ Prop. Line ....... LEACHING LINE its' No. of Lines . .3 - _.. -- Length of each line Total Length -f- `---- --_. 'D' Box j-„ .-k.T.ype Filter Material .....-�-R._._._._Depth Filter Material -_._.I.1T.....--- ........ .......... S f Distance to nearest: Well-_.._ .�3._ Foundation ?. .---..-- Property Line ..... .................. f SEEPAGE PIT [ Depth .. r Diameter -.7- Number ...-_...�........ ........ Rack Filled Yes No [] Water Table Depthkd—:------------Rock Size .....•... Distance to nearest: Well J. --------Foundation --._.�� - Prop. Line _._. /`''....-..-• p iREPAIR/ADDITION(Prev. Sanitation Permit#'.•_:,__----------- -- --- --------------- Date ----------------•-----------------) Septic Tank (Specify Requirements) ... ._. .. -------- Disposal Field (Specify Requirements( -------------- ---- ------------------------------------- ....... .............-.......... •----------- ...............----.............- ._. ...... ------. ...-. .............. w.. f ......................... .....:.........-................- . ..........------ ... ..------ ---------- --------- ... ---- •--------.......... .......---...-.. ..... (Draw existing and required addition on reverse side) 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, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed .:.. . ....... ......... ....... Owner ' f Title . .... ......... (If other t an owner) . OR DEPARTMENT USE ONLY i J APPLICATION ACCEPTED BY . . ... --: DATE ..� .. ... ... ..................... BUILDING PERMIT ISSUED ..... .......... DATE -..-.. ADDITIONAL COMMENTS -..---.------:---- - ...----•- ----- - -------- _... _...._._.-`_...._ ---- ---- --- ------- ----- -- ---- ----- _ ...- ---- Final Inspection b Date ..� ._ ._..- •--•- --, M AN JOAQUIN LOCAL HEALTH.-DISTRICT „ M )s 71723 r..