76-199 - Laserfiche WebLink

Metadata

Thumbnails

Annotations

OR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No ..................... .......... 0 '7� ............... This Permit Expires t 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 Count Ordino ce No. 549 and exists Rule and Regulations: JOB ADDRESS/LOCATION J. _, .��......--- _... 5 /../v... � .- ...4/4&USFCT ........ . ....` J . . ........... Owner's Name . . ............................ .. . . sad. / .'�//✓........ _ /-��.SA.._- -c.�l_ ..�1�'..�Lf�-�..... . . . ...... ... ..Phone Address ��c.�.�a ../..v/L`�' i� G .. lf. ................. City fy q.. .lsU /�4�... Contractor's Name C - yl. ..............................................Licen .,yYJ/ .... Phone 4. c�...��. Installation will serve: Residence(Apartment House Commercial❑Trailer Court Motel ❑Other .................................•.......... Number of living units:.... Number of bedrooms 7Z- .Garbage Grinder ............ Lot Size . ............. Water Supply: Public System and name ..............................................................................................................Private [ Character of soil to a depth of 3 feet: Sandy Silt❑ Clay ❑ Peat❑ Sandy Loom ❑ Clay Loam ❑ Hardpan❑ Adobe ❑ Fill Materlal ............ 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 ------ -------•----- aterial...................... No. Compartments ...................... 6 ----------------- Distance to nearest: Well .................. .............. ..Foundation ----- ................ Prop. Line ......................�--1 LEACHING LINE [ ] No. of lines ........................ lengt of ea ine............................ Total length ............................v, 'D' Box ...... --... Type Filter Mat al ....... ...........Depth Filter Material ...............:............................ Distance to nearest: Well ...... .............. . Foundation -....................... Property Line ........................ � SEEPAGE PIT [ j Depth taiam r ......... ...... Number ..._.... ............... Rock Filled Yea ❑ No �❑ Water Table Depth .... .....--•........Rock Size . Distance to nearest: W I .......................................Foundation .................... Prop. line ......................V' REPAIR/ADDITION(Prev. Sanitation Permit d` ............... ........................... Date ................................. } SepticTank (Specify Requirements) ....... ............:..•-•----••...................••---•••....-----•-•................-----•-----•---....................................... , Disposa F'el (Specify Requirements) ._..-.--•--•----- -- ................................. ---------------........ ;l .. .._ c ry-/1....--, Jtr� '...... ----- �.. ... l - ---------------------- - ------ --------------------- ----------------_-....................... -----------------------------------.•---........................... (Draw existing and required addition on reverse side) 1 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 Hearth:District. Remo 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 shalt not employ any person in such manner as to become subject to Workman's Co pensation laws of California." Signed --- ----------- - Owner By --------- --gother 3itle ---._.---- ------...._... ............. (If owned FO EPARTMENT USE ONLY APPLICATION ACCEPTED BY . G?/---- - --- --- - ------ ------------ . - __...__-.. DATE BUILDING PERMIT ISSUED _--_ - .. ..DATE . ------- --------- --------- ADDITIONAL COMMENTS ........ _............................. - _.:.. --------------- --------- _.... ----- -----------_.._.........._.....- - ... --------------------- ............--............................................. _...._.......................... ... ...........................----•----------. ------- - . Final Inspection by: Date . .�. :. .� ........... EH 13 22t 1-613 Rev. i SAN lOAG2UlN LOCAL HEALTH DISTRICT 8/7h 3M