76-238 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USEt .................. fl Y7r ...... ••---•---- APPLICATION FOR SANITATION PERMIT (Complete In Triplicate) Permit No. .71 .` J� .......... ....................... .....• Phis Permit Expires 1 Year From Date issued Date issued ..... ....... Application is hereby made to the Son Joaquin local Health District for a permit to construct and Install the work herein described. This application is mode, in compliance with County Ordinance No. 549 and existing Rules and Regulations: � JOB ADDRESS/LOCATIO ! ':.��Zv - .. ... ..i-._..............._.... ............-... .. + .. Owner �' �E., 4• a F._ .:.................. CENSUS TRACE ..... 's`Name ® .... Address . �"'�` .�"', .� .. . : .. l Phone�r 9.`.. ...... ry ,�� r ........ .... Contractor's Name ' FL y ..................... r. r!/ ..._..._ _. lienee #�JT -- •. Phone Installation will serve: Residence.K.Aportment-House fl Commercial ❑Trailer Court ❑ " Motel'E]Oth r k-: .. ............... j Number of livingun -._.. Num ber eVbed oms�M....�.__.GarbageGrinder .. . Lot Size F Water Su r _... .... r pply: Public System and name t a . P Character of soil to a depth of 3 feet.,, Sand❑ Silt clay 6 j . ...... ........ Loa Private ❑ �-• i to ._. p Y #7 Peat'❑ -Sdndy Loam❑ Clay m [3 Hardpan❑ Adobe ` ,-FIII`iA6terial .___.....if yea,type (Plot pian, showing size of lot, location of system In rreldt€on wells, buildings of�mf ust be placed an reverse side.) NEW INSTAI<lATION: (No septic tankor seepage pit permitted-if.public isewer�is available within 200 feet.) PACKAGE TREATMENT ( J SEPTIC TANK t ] Size. .• --••--;-•---•............................ Liquid Depth Capacity ..... .....Ca TYPe Material.............•------- Not Compartments I Distance to nearest: Well --Foundation p. Line --------...-�---•--••--- ....:--- Pro LEACHING LINE [ I '" •• .-..........._..... No. of Lines- ------------------------ Length of each line.........-........ -_.-_. Total Length D' Box .------°__..IType Filter Material ............. .....Depth-Filter Material ............... Distance to nearest: Weli _...................... Foundation ........ _....--- Property Line ........................ SEEPAGE PIT -�_ { ) Depth ..............t Diameter .. ........ ---- Number .................. Cn _.`.......... Rack Filled Yea ❑ No ❑ Water Table Depth --------------• R { Rock Size ....J........ ............... .. Distance to nearest: Well ---•--------t__....._ I=ounda#ion ... ._._ e ........_. Prop. Line ...................... p TIONIPrev. Sanitation Pe.rmit# --------.--•------------------ - Date . ) O f REPAIR/ADDI ....................... Septic Tank (Specify Requirements) .._:..._ - Pr. _..... .. .............J........... . Disposal Field (Specify Requirements) ,6 ...... -------------------•--- f----- _y. -� ,"-- =, - --------- - - -------- _ lDraw existing and req ad ' '_ q dition on r ---•- t . _ everse-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.©istr(ct. Home owner sed agents signature certifies the followintg: I or Men- "I certify that in the performance of the work for'which this pennit is issued, I shall not as to become subject to Workman's Cemploy any person to such manner ompensation laws of California." Signed ......... ` � - -- ---...,----- Owner By ------- - - ------ f a t Title _. {If oche n owner) ...--....................... ........... .......... t FOR DEPAITMENT USE ONLY APPLICATION ACCEPTED BY ...... r l BUILDING PERMIT ISSUED ..-----..._'_..:.^�• :: -------- ...... -- ....-----•---_.. DATE .._..��. .. 7� 7 ADDITIONAL COMMENTS -------- •------ - ••------ .., =�... _r..:.:,;_................: DATE -- - r J.d J ---•- ..._.. ________ y __....._ ......_..__�:.-_.._..__. _T______.._.,,._.--____,,....................:------.-__.--__...-_......__.__.._.__......_-.__ _.__....__.�__....._____-- ___._ .:_..._ ......................... ...................... ............:__.__.. .__---...... _-___.__........-_ Final Ins ection b - ------------------•- .....................__........_..---- - EH 13 24 1-68 iterv. 5m -- Date ... ..�. ................ ... SAN JOAQUIN LOCAL HEALTH DISTRICT 6/7h 3M