74-767 - Laserfiche WebLink

Home Browse Search

r FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit NQ711...------..,./ ...._.. ....... This Permit Expires T Year From Date Issued Date Issued Application is hereby made to the San Joaquin local Health District for a permit to constructand install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION . ..-- - ---- m. ....... , CENSUS TRACT Owner's Name ...................._. :-T2...0-.---'K67-azC(t..t ..--• ••-- ..---------Phone ....�5..`_aaTS Address .Sf City -------------•----- -•---------- ......--•--. ...... .................................................... Contractor's Name .. .... ..... . _,0c �... -- ._ - - -- ---- --- ---------- -----License # . ----- ..._.....---- Phone --------- ...... . Installation will serve: Residence ❑ Apartment House❑ Commercial ❑Trailer Court 0 Motel ❑Other .. .. .. . ...... . Number of living units: .......... . Number of bedrooms ..----------Garbage Grinder ......... lot Size ..... --..____..____. .. Water Supply: Public System and name ........................ ..............Private ❑ Character of soil to a depth of 3 feet: Sand b Silt❑ Clay ❑ Peat(] Sandy Loam (] Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material ___ . .. If yes, type ..-..- . (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"Iaublic sewer is available within 200 feet,) PACKAGE TREATMENT SEPTIC TANK - � � Size --•----•------•. .......... ......_ Liquid Depth ........................ Capacity . Type ------- Material.... ..- No. Compartments i� Distance to nearest: Well . _.... . --- -..---_--•-•Foundation ..... ....... ........ Prop. Line ..................... LEACHING LINE [ No. of Lines Length of each line ..... . _,..-.. .... Total Length W 'D' Box .. . Type Filter Material ____________________Depth Filter Material ........ ..... Distance to nearest: Well ... .................... Foundation . ---- Property Line - --------------........ 5� PIT C Depth - -.. .. Diameter ---------------- Number ... Rock Filled Yes ❑ No Q Water Table Depth -------- _------------------------------------Rock Size = Distance to nearest: Well ...................._------- ------_Foundation ..... .... . ....... Prop. Line ...................... 1 REPAIR/ADDITION(Prev. Sanitation Permit# ........ ..........--- ------------.-------- Date _....----------------------------- Septic .__....._ ---- Septic Tank (Specify Requirements) . . .. ..r��"1 p�........ -S,`_X_-3a"_. Disposal Field (Specify Requirements) .--------------------------------------- ----- - ---- --------------- ------------------ --------------- -- --------------------------- - n (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, Horne 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 Wo km kman'srCompensation laws of California." Signedd` .._� "l4 c.�1r�-c1 Owner By . . .... ............................... Title (if other than owned FOR DEPARTMENT USE ONLY — APPLICATION ACCEPTED BY . - --.._.. .. . . .. ... ---. DATE BUILDING PERMIT ISSUED ..--..- -.----.._...... .. .... ._DATE .. ..... . ..�7�' ADDITIONAL COMMENTS .... ---•---..... ._-......._. _ .......... .................. ............. ........... •-•--------_ .... ....... --. --- • -- ...--•.............. - .....----- •...---- Final Inspection by: ... __ ....- - --...------ --•............... Date l SAN JOA UIN LOCAL HEALTH DISTRICT E. H. L3 24 1-'6$ Rev. 5M 117? 1 u