74-1038 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: _. ....._111.4 APPLICATION FOR SANITATION PERMIT _ )Complete in Triplicate) Permit No. ...� `�a 3. 1111... ... ............. ..�..._...._..---...1111- - .. . ............ ..................... — This Permit Expires 1 Year From Date lssued Date Application is hereby made to the San Joaquin Local Health District fora 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 %_.. G'�- J �I Com% CENSUS TRACT .... . ..... ......... Owner's . . . Name i�L�C' ��/`'� ��. ��.' .Phone 111 1---... ..... ... . .._ . .--- Address ....... City . Contractor's Nome 7 ............................License #c .7/sC} 1... Phone Installation will serve: Residence partment House f] Commercial ❑Trailer Court Motel ❑Other _ 1111 ...... ................. �! r Number of living units: . ..__.. Number of bedrooms -.?......Garbage Grinder.. Lot Size . L....(l..t- Water Supply: Public System and name ------------- -- ................... -------------- ................. -------------..............Private Character of soil to a depth of 3 feet: Sand'❑ Silt E] Clay [:1 Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe Fill Material ............ If yes,type ............... 1111........ (Plot pian, 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 LINE [ ] No. of Lines ----------- ------------ Length of each line -- ---------- - ... Total Length 'D' Bax . __. --- Type Filter Material ..............Depth Filter Material 1111. - ..........I----------- ..........- Distance to nearest: Well ................ Foundation Property Line ........................ SEEPAGE PIT [ ] Depth ---------- - ----- Diameter _-.............. Number ..... ----.._....... ...__. Rock Filled Yes ❑ No C] Water Table Depth --..... ---------------- ----------------------Rock Size 1111 ---------- .......------- Distance to nearest: Well ............................. ------Foundation - --.-----.- ------- Prop. Line ......,............... REPAIR/ADDITION(Prev. Sanitation Permit# ---- -? _��_1J..........------- Date ........ Septic Tank (Specify Requirements) ------------- ----- `' --------------------..------.-.------------•---------- Disposal Field (Specify Requirements) --.-- .�;�✓y- �.-1111-- .- -- .�f -- .. ---. G'._�_ �c_�. ........... . ............ .......... ------------------------------...__.------..---- ---------------- .... -------------- (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. Homo 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 C t Owner . 1111.. � _ .. / - --1111.. . ................ . ../ By ------- ---- `� Title lam" ..- 111 1---1111. . - _ ....._. .._ ........ 1111..., . (if of �er t -owner) 9 F R DEPART llSE ONLY APPLICATION ACCEPTED 8Y VKS ;Z -_-DATE //. �...:` l . BUILDING PERMIT ISSUED .._ DATE ------ -- ---- - - --- . ...... ------ ADDITIONAL COMMENTS _.. ... .. . _... 1111 .. ... .. . Final Inspection by: - --- ---------- EH �!. . f -'...r Date J �-J. .3 _ .. 1111 �3 2a 1-b8 Rev. 5m SAN 0AQUIN LOCAL HEALTH DISTRICT 8/7h 3M