76-1085 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: �....... .f.-•--•-...,,.. APPLICATION FOR SANITATION PERMIT ......... _. ......... .. (Complete In Triplicate) Permit Na. . . ............. ..:........... 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 instal) the work herein described. This application is mode in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ......1.. .3 0 �� ar�l► .,:, ....* .. . ... ............. .......CENSUS TRACT ........ Owner's Name ,Hv.....L� ................. ................................. .................... ......Phone ...., Address d-... L . . ' r. ... .. ...... .....City -.A?..')l,,n ,�..t,R,...... ........... ..,....... Contractor's Name ........... ............--_----_--•--_- ..............................License # ........................ Phone ..............,............... . Installation will serve: Residence P Apartment House fl Commercial OTrallw Court C3 .� Motel❑Other............................................ ♦� Number of living units:............ Number of bedrooms ............Garbage Grinder Lot Size ............................................ Water Supply: Public System and name . •---•-•••----••••........................................................................................ .Private ❑ v1 Character of soil to a depth of 3 feet: Sand❑ Slit❑ Clay ❑ Peat❑ Sandy Loam 0 Clay loam ❑ d Hardpan❑ Adobe Q-_ Fi#1-M6ter1oI_- _._.-... Jf y4W type .._.___..... ........... - - (blot 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 240 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK{ ] Size................................................ Liquid Depth .......................... Capacity --------------_- Tyle .................... Material.....-----------...... No. Compartments ...................... Distance.to nearest: Well ....................................Foundation ...................... Prop. Line ...................... LEACHING LINE [ I No. of Lines ---------------_-----. Length of each line............................ Total Length ............................ 'D' Box ............ Type Filter Material ....................Depth Filter Material ............................................ ` Distance to nearest; Well .................-...... Foundation ........................ Property Line ........................ SEEPAGE PIT [ ] Depth .................... Diameter ................ Number ........................ Rock Filled Yes ❑ No C3 \ Water Table Depth --•••---•-- •------••-•...•-•...................Rock Size ................................ Distance to nearest: Well ........................................foundation .................... Prop. Line...................... REPAIR/ADDITION(Prov. Sanitation Permit# .........._:................................ Date .............................I Septic Tank (Specify Requirements) ........ ---•--••...........................................................---•-•......................... ............................. Disposal Field (Specify Requirements!; Of oe z, ..................... �a...,k .. ........ .. .................................... ............................ . ....... ................ (Draw existing and required addition on reverse side) I hereby certify tho have prepared this application and that the work will be Mane In accordance with Seen Joaquin County Ordi es, S o Laws, and Rules and Regulations of the San Joaquin Local Meow,DifMicf. Homo +owner or licen- sed Ogen signature c )fins the following: ••# c that in the erformance of the work for which this permit k issued, I shall not employ any person in such manner as t *come sub! to Work p sat' laws of California." Signe ` -- �` Owner By --- . ........ ....•. Title -------- ............. ... .. ................... (if other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .. . ...... .............................. ........ DATE BUILDING PERMIT ISSUED ----•-••... .... .... ...................DATE _ ADDITIONAL COMMENTS --.. .. ---•----------......................• ... ..... . .......... .......... . -- ...---...........,. ..3. Final Inspection by: .. . . ----- -• ................................... ..... ...... Date ..I. l.. ....... EH 13 24 1-68 Rev. 5 SAN JOAQUIN L HEALTH DISTRICT 8/7h 3M