76-341 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 7 6_ 3`1/ .-- ............. Permit No. - (Complete In Trlplicatel 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 Ordinanc No. 549 and existing Rules and Regulations( JOB ADDRESS/LOCATi l�-'.. .....(eft . .... . . .... . QNB .'-..,�� .....CENSUS TRACT .......................... Owner's Name ................. ...... ......• ,,. ...............................................................Phone Address ..._..._...................___......ad --- City � .... ! ....................................................... Contractor's Name ..... _R:."T" ._`...... ...... ..License # ........................ Phone Aak. A!2 Installation will serve: Residence 'Apartment House 0 Commercial oTrailer Court 0 Motel 0 Other ........./........ ....... .............. � Number of living units:..._1..... Number of bedrooms ..`,Y`.....Garbage Grinder ------- .... Lot Siz _. � - t�..t~.-/_.----•-•- Water Supply: Pubtic System and name ----------------------------------....................._.�; ................private Charocter of soil too depth of 3 feet: Sand o Silt❑ Clay ❑ Peat Q Sandy Loam o Clay Loam o Hardpan K Adobe j� FIII Materlol............ If yes,type ............... ............ _v (Plot plan, showing size of lot, location of system in relation to wetis, buildings, etc. must be plated on reverse side-0 NEW INSTALLATION: (No septic tank or seepage pit permitted If public sewer is available within 200 feet,( J PACKAGE TREATMENT { ] SEPTIC TANK i` J Size .. .......................................... Liquid Depth .......................... Capacity -----------•-----_.. Type = .............Material......._ . ........... No. Comp artments .....................fff Distance to nearest: ,Well .Foundation .... Prop. Line ....................... LEACHING LINE [ ) No. of Lines-'! ......t. _..------- Length ;of eachline............................ Total Length . 'D' Box .... ae.... Type, Filter Materi . ...............Depth Filter Material ............................................ Distance.to-swamsto Ellett Foundation Property Line ........................ SEEPAGE PIT { j Depth .................... Diameter ................. Number ............................ Rock Filled Yes 0 to Water Table Depth ----+---••................... •-----..Rock Size -.............. ................ Distance to Nearest Well ..................... ...Foundation ............... Prop. Line .....................S REPAIR/ADDITION(Prey. Sanitation Ptrrr�i� ... Date ...................................) r Septic Tank (Specify Requirements) .... ..X.t. ... .. .. .... ........................... ,.........._............,.., Disposaf Field (Spe(' Requirements).. _. • --• ` -5.�......................................................---. ............. #1....4,m_ __ �;;�-117 V -------•------------------------------------------ ................................................................. -•---------•---•--------------•-----....---...----••-•---..._..............••...... (Draw existing and required addition on reverse side) I hereby certify that 1 have prepared this application and that-the work moll be done In accordance with Sem Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or lice* sed agents signature certifies the following: "i certify that In the performance of the work for which this per is Issued, I shall not employ any person In such manner as to bec a subject Workman's Com sation Iaws f Catlf�isr." Signed g ... .. . _._ .. By -=--------- --------------------------- ................................... 3 #e ,.� - --------------------------------- (If other than owner) R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .-. . --- - ................. DATE ------- BUILDING PERMIT ISSUED ......................... . DATE - ................----.----_-. ADDITIONAL COMMENTS -- .. .. .---_-_-. ..... ..., ........... .. ----•--•................... ----------------...... .� ... ..i......... - --------------- -- ------------- ..... _................... _..................... _/. : _.^..*.� .. Final inspection by: ................ -• • .............. ..........---........._........Date .. 7 . ........./. EH 13 24 1-68 Rev. 5M SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3M