74-161 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: 10APPLICATION FCNR SANITATION PERMIT y y Permit No. _7.... .. ----------------------------------- � (Complete in Triplicate) ......... This Permit Expires 1 Year From Date Issued Date Issued _________________________________________________________ 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: JOB ADDRESS/LOCA ON ._A/�f--- 4�Q c---- �`'t` CENSUS TRACT --------- /� f Owner's Name u(- C. Ltt �,� ----------------------------------- ---------------- -------Phone ------------------------------- Address -cS - GLC � ' /------------ City Contractor's Name ---- ----------------------------.License# ---------- ------------ Phone ---•----------------- ........ Installation will serve: Residence [Apartment House❑ Commercial [-]Trailer Court ;❑ Motel ❑Other -------------------------------------------- Number of living units:_____f___- Number of bedrooms ___3----Garbage Grinder ---�- Lot Size ----- ____________________________ Water Supply: Public System and name ---------------------- ----------•--------------------------------•-------•--------------------•--•----------Private [5f Character of soil to a depth of 3 feet: Sand❑ 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 public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK[ ] Size------------------------------------------------ Liquid Depth ------ ------------------- Capacity -------------------- Type ------------------- Material------ ---- No. Compartments ...................... Distance to nearest: Well -_________________________________Foundation ---------------------- Prop. Line -------------_------ LEACHING _•_-_- . ---.__LEACHING LINE [ ] No. of Lines ________________________ Length of each line---------------------------- Total Length ----------- ................J� 'D' Box ------------ Type Filter Material ____________________Depth Filter Material -------------------- ----------------------- Distance to nearest: Well _______________________ Foundation ------------------------ Property Line ____-__-.-_--_-•,._._- SEEPAGE PIT [ ] Depth -------------------- Diameter ________________ Number ------ --------------------- Rock Filled Yes ❑ No i❑ Water Table Depth ------------------------------------------------Rock Size -------------------------------- Distance to nearest: Well ---------_----------------_------------Foundation -------------------- Prop. Line ...................... Q REPAIR/ADDITION(Prev. Sanitation Permit# ____________________________________________ Date _______--_-.__--___-_______...____) 3 s Septic Tank (Specify Requirements) ...CZ_G _...__l12p. _ __` �___t... a,___ __ + --- --- _ Disposal Field (Specify Requirements) t��'ii�� ---------- d -5------- _ --------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------I----------- (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. 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 BY - ------ Title ----------------------------------- ------------ (If o r tha owner) Fq# DEPARTMENT USE ONLY APPLICATION ACCEPTED B - ' ---------------------- . DATE -' � ---/ PERMITISSUED ---------------------------------------------------------------------------------------------------------DATE ------------------------------------------- ADDITIONALCOMMENTS --------------------------------------------------------------------- ----------------------------------------------- --------- ---------------------------------------------------------- --------------------------------------------------------------------------------------------------------------- ------------------------------------------------ --------------------- -------------- ------------------------------------------------------------------------------------------------------------------ -------------------------------- ------ ------------ ------s------------------------------------------------- ,.� ------------ Final Inspection by: ---- - -- 1 ------•---------------------------------------------------Date 7 rf r SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M