75-369 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: I APPLICATION FOR SANITATION PERMIT .... ............................... ................ Permit No. .......... ;. -ICompletiin-Triplicate). ...��, _. .. ._.. ._ ... � .. ............................................ This Permit Expires 1 Year From Date Issued NDate Issued _.: . S '3 Application is hereby made to the San Joaquin Local Health District for a permit to constrtict and install the work herein described. This application is made in compliance with r}t�jr fOrdinante No. 549 pnc4 ex#st#ng Rules and Regulations. .z yrs �� -�" ., W ,o t'ne(._.: �!.!..�e. ears }�... CENSUS tRACT .... JOB ADDRESS/LOCATION -....N�. ....-. . . --- _.... Owner's Name ---DK,3n.......5Vg q;n 9gn................................................,•-----•............... .....Phone -••--- Address ...... ...... -!k Z A..... .................____............_.... City......AYi. ...'��.----------------------------------._._:.._...--- Contractor's Name ----- �'.___.__-a-S-• - V�t --------•- •--- •---....•...........:.....:........License # ....`1-`......._:.. Phone .................... ,I Installation will serve: Residence❑Apartment House 0 Commercial{gTrollerCourt f& Motel ❑Other _.._........................................ Number of living units--..... ..... Number of bedrooms .._.........Garbagerider ............ Lot Size __.-.....__..___.........___.................... Water Supply: Public System and name _.-_Q; ._--... _ .. ;�..._......:............. Private Q. Character of soil too depth of 3 feet: Sand o Silt o Caay. ❑ Peatr-1 Sandy Loam J3 Clay Loam 0 } Hardpan Cj Adobe 0 Fill Material ............ If yes,type............... .....:...... f (Piot plan, showing size of lot, location of system In relation to wells, buildings, etc. must be placed on reverseside.) it NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200:feet,( PACKAGE TREATMENT [ ] SEPTIC TANK f ] Size.............. _ Liquid Depth ----__ 1 CapacityType .... Material...................... No. Compartments 00' Distance.to nearest: Well ...................:................Foundation ....................... Prop. Line ...................... %P LEACHING LINE [ J No. of Lines --_--------- ------ Length ofeach line_----------................. Total. Length ------------------_._.--_--- © Box Type Filter Material ......Depth Filter Material = !I Distance to nearest: Well ......................:. Foundation ---..:.................. Property tine .............. ......... SEEPAGE PIT [ ] Depth .................... Diameter ............. Number ............................ Rock Filled Yes No C Water Table Depth ........................... ._.._ _........Rock Size ..............__-_.__-__-----_-. If Distance to nearest: Well ............ ...... ..Foundation ...................... Prop. Line ; REPAIR/ADDITION(Prev. Sanitation Permit# ................................ ___...__ Rate -.._....:... .:.._,.... 1 N - - Septic Tank (Specify Requirements) ................................................:.............................................................. Dikp9sat Field (Specify Requirements) ........= !- ..._.. ... : ....%` � q)"RI�t� s (Draw existing and required addition on reverse side) l T. I hereby certify that I have prepared this application and that the work will be done in accordance with San Jeagnin E; County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local Healthy 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 shalt not employ any person in such manner as to beco!re su ct"orkman's Compensation laws of California." Signed '•-- -------------------- - ............................................... Owner By ----------------•------------------------------------------------------...-.......---..............._.. 3.itle .--- -------------- .......... -- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --- - . . _.- -... . ---•- .... .................... DATE .... _. .. - .S.. j BUILDING PERMIT ISSUED ............... ---DATE ------- ................................... AU IT CiNAL COMMS TS --- �. :..... ..... ..... - --• -..-..._ al Ins ection b --• -- -- Date .� f D.- '?.5.. :... P y: .. t...-.. f 3 , EH 13 24 1-68 Rev. 5M SAN JOAQUIN_LOCAL HEALTH DISTRICT 8/7h 3M