76-112 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ............... /._�-...... .�''f fir-._ .... Permit No. 7 t _�! Komplett in Triplicate) .......... ....................,l...---:.'. ?r7 .................... This Perm"Expires i Yew 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 9rdinance No. 549 and existing Rules and Regulations: .� ��. JOB ADDRESSjIOCATION . ,.�./.�`_...... t :Z....../.fCE ............................................ NWS TRACT .........,................ Owner's Name .:��- ... .............................................................. .................................... Address . . .:..Sa17".e--------_- �--� city ..�'��.�.-,t��.. _ Contractor's Name .....�.0/.:,_eo /.��.�.............................License!Ir Installation will serve: Residence 0 Apartment Hawse 0 Commercial E3Traller Court 0 Motel❑Other............................................ Number of living units:.../------ Number of bedrooms _/.......Garbage Grinderr(�Q.. lot Siz Q, ....Z. ., ._,`.... Water Supply: Public System and name ..._..... ................._...........................................................................Private, Character of soil to a depth of 3 feat: Sand 0 Slit 0 Clay ❑ Peat Q Sandy Loam-0 Clay Loam❑ Hardpan Q Adobe jW Fill Material ............if yes,type............... ............ 1PIot 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 f ] SEPTIC TANK f j Size................................................ Liquid Depth .......................... Capacity -------••--•--•-••-- Type --•--•-------------- Material..........-----....... No. Compartments ....................... Distance.to nearest: Well ......... ............. .....Foundation ...................... Prop. Line ...................... LEACHING LINE j j No. of_Lines ..................... Length of each line............................ Total Length ,.................•.....,.,.W 'D' Box ............ Type fitter Material ....................Depth Filter Material ................:........................... 6 Distance to nearest: Well ........................ Foundation .......:................ Property Line ....................... SEEPAGE PIT O Depth .................... Diameter ................ Number ........._.. ............... Rock Fitted Yes ❑ No ❑ Water Table Depth ................................................Rock Size ................................ Distance to nearest: Wolf ........................................Foundation ..................... Prop. Line ...................... REPAIRJADDITION#Prov. Sanitation Permit#-------------------------------------------- Date .................................. Septic Tank (Specify Requirements) ......................., . ....,.._.... ... .....:............ ........_.............,._........... Dispo l Field (Specify Requirem ts) ...�..!.. __..�,i�. .... /+-sem°. ------------------------------------------I. -----------------------•------..-.........----_............_....-------•--...................................................._............ (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that " work will be done In accordance with Son Joaquin County Ordinances, State laws, and Rules and Regulations of the Son Joaquin Local HeaW Dist id. Heats owner or licm sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, I shelf not employ any parson in such manner as to become sub act to Workman's Compensation laws of California.,, Signed --------- ------- -- ........... --- - Owner By .......... ... . Title - "' 7- - ------ other than owner) - FOR DEPARTMENT E ONJY APPLICATION ACCEPTED BY-----_... „� .,.: DATE -1 ..1.x..... .... BUILDING PERMIT ISSUED .. . = :1�?......DATE ---------------_......._...• ......... ADDITIONAL COMMENTS ...... ....... a. ... . . ......................................... .gat:.. . .... • . •... . - ......................... .... .. ..... ................... ••---- ------------- ..... ...--- --.... { Final Inspection by: ... :;: ....................................... ...... . . :.......Date-;X '� ............. .. EH 13 2!e 1-68 Rev. 5KSAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3M