76-1050 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 76 ................. (Complete In TripHcate) Permit No ... ............ .' ......-.. •_........•.........•......................... This Permit Expires t Year from DaN Issued Date issued .1/Zf 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/LOCATION . ....�, ../. : ./ / Q� .....................CENSUS TRACT ..........-. . _ Owner's Name Address _.. .....Phone/.-'.. 1� ....... /{-/.` /.�D ,O;_...l� ��G'1 ��.....City d.�Gr�� _.......ex... .................1 -�.. Contractor's Name .. -sx,_ .....X45_..__ .�? c� ..................................License # .20/S D... Phone ...._............._----_--- installation will serve: Residence 0 Apartment Hou/se0 Commercial QTraller Court J2 Motel Q Other..X12.rJ-t�-�••r---1 ,�.�artt. ,.- g Number of living units:..-_ -.... Number of bedrooms/./.2,......Garbage Grinder 1es�... Lot Size---------_-_------------- Water Supply: Public System and name ........._...............•...._-...........................•..............._.._.....Private Character of soil to a depth of 3 feet: Sand 0 slit Q 1Gay 0 Peat❑ Sandy Loam ❑ Clay Loam � Hardpan, Adobe 0 Fill Material ............ If yes,type............... ............ W (Plot plan, showing size of lot, location of system In relation to welds, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted If public sewer available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK W Size......,t! Z ................ Liquid Depth ... - -.__------ Capacity -.iIV 0?------- Type COk�=alggZ.Material........................ No. Compartments ----2------------ - Distance to nearest: Well ._ Prop. Line ------.....��Qtr2................FOundation .......I�.`3O........ ......W.............. LEACHING LINE [ ] No. of Lines ._.._ 2._.------ --- Length of each line.-_....._..TA............ Total Length. .....]lrr)...... ...... 'D' Box .. ---- Type Filter Material Depth Filter Materia! ........E2................................. Distance to nearest: Well ...1.00-........... Foundation ......W.........._... Property Line .... ............ SEEPAGE PIT [ j Depth Diameter ................ Number --------.--.__.--_------.-. Rock Filled Yes a No Q WaterTable Depth ................................................Rock Size ................................ Distance to nearest: Well ...I . ..... ...................Foundation .................... Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit ,1..................... Date ._/.�, �1,� 6........) SepticTank (Specify Requirements) ................................................................................................................... --..................... Disposal Field (Specify Requirements) ....................... .... ...............................----.............--.............---- ................. ------- ---------------------- ------------ -----------------------------------------_................................................................................ ........... (Draw existing and required addition on reverse side) 1 hereby certify that 1 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." Z-1— Signed , - 1 �,1C 1�.._--- --------------------------------------- Owner By ----- --------------------- ------ Title ------------------- --- --- (if other than owner) - FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY . ..... . . •---------•- --------------- ----------- ----------------- DATE .Z. ./.. -. J - - .- 7.i ------. ---. _ BUILDING PERMIT ISSUED ---- _................. .. ...............-_.---... ------- ----......------.._DATE ADDITIONAL COMMENTS --------- -----............................ _................._---.. - ----------------- ••---------- -- ----------------- -- - - ...... .. ................•-------.......---- .......... --- ----- . Final Inspection by: ... - •------------•-•----- -- .............. Date - H 13 2!� 1-613 Rev.� ' � -----,....--•- ,L. .. ..�.f'•.. - -----•---- SAN JOAQUIN LOCAL HEALTH DISTRICT 3M