76-527 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICAMM•FOR SANITATION PERMIT .............................. -•--....... ............. Permit No. .76._. 1 .IComplete ln-Triplicate) .....:.............. .....:..............:.... �Date Issued ....1� ...... This Permit Expires I Year From Date fswed ............. 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 County Ordinance No. 549 and existing Rules and Regulations: k - JOB ADDRESS/LOCATION ......... .......................CENSUS TRACT -•------------.-:_._..._._ Owners Na 11 e r N _91,41244................................. ...Phone . `. ..------ Address X1.1...... . I'_ar .� city ... kW -4..--...---•- --....-.... Contractor's Name .........__�_CLADP9R................. .....License # ............. Phone � ....--...... '�. Installation will serve: Residence{'Apartment House's Commercial❑'Trailer Court 0 I� Motel❑Other... ............ ................... Number of livingunits:-..-.I - Number of bedrooms " .._. Lot Size ^ � --..._.Gd►bage Grinder ....._.. ..................' Water Supply.[Public System and name ..................................................................._.......................................... Private p Character of soil to a depth of 3 feet: Sand d Silt❑ Clay ❑ Peat❑ Sandy Loans lay Loam❑ e Hardpan Q I 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 iNSTALL6ON: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) +' I/ PACKAGE TREATMENT [ ] SEPTIC TANK Size.......�.� �?.. 1� .................. Liquid Depth ._.'1�i........-....... Capacity _1_ ....... Type -- :.--- Material... No. Compartments ___2............... . Distance.to nearest. Well ...Foundation L�........... Prop. Line -. ............ I LEACHING LINE [ ] No. of Lines .-__.._..3......____.. Length of each line........_ ............ Total Length ... .1.(0............. 'D' Box 1....... Type Filter Material .Iaeptlt filter Material�{7. -.... ......1. ..11 ..`.............. p P � Distance to nearest: Welt .._ .� .......... Foundation ...., .5.............. Property Line 6.._.......... SEEPAGE PIT [ ( Depth -----------_-_... Diameter ................ Number ........ .................... Rock. Filled Yes [] Nocp + Water Table :Depth ......Rock Size @ O . ..._...foundation ...... Prop. Line Distance to nearest: Well ...:..:...:...................... ._..F .: REPAIR/ADDITION(Prev. Sanitation Permit ....... Date Septic Tank l(Specify Requirements)._..:............------......__.......:'..........------._........---.......;...:....--........----:........--•.-----........--...... .:..: DisposalField #Specify Requirements) ------ ------------------------------ .......................................................................................... ........... ` -----------------------------------•- ---------•-----------------•--•• --------- ...------- =----------------------------•----------•-------------- ' ' (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 wills Senn Joaquin County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local Heallh:tsistrict. Hance owner or 11cen- sed agents signature certifies the following: "I certify that 1"?e performance the r or which this permit is issued, ! shalt not employ any parson in such manner as to becomes le t to Workma omp s ion Raws ol.Califarnia." g �k.. - �`� Owner Signed ......._. •s By I --------- ------------- .......................... Title ....................... ...................... ............... Of other than owner) FOR DEPART SE ONLY BUILD APPLICATION ACCEPTED BY .. .. .............. ............. 4 DATE _._....._..':.I�-ZG�--------------- MIT ISSUED --•------•...-----•-- ----DATE . ......................................... ADDITIONALCOMMENTS ----- ------------- ----••--------•-•-------•---------- -----------•--•............ -•----..... ............... ........................ ..--------------........... -----------------....----------.----------------............... ....--_.____-.._ . .....................---.-..-------------------------- ______________________________._.....__.__.............__.___._-_______.___...._--._.___-___--_____,__-____..__..-c___- ._..-____-_.- Final Inspection by: ------• -------------------------------- --._......._..---•--•........---•...._... .....Date _.... 6. - _ ------- --- ..-.........--._ EH 3 2h1�-613 Rev. f. SAN .30AQUIN LOCAL HEA4H STRICT $/7)j 3M `�J J 1