76-805 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. _ .. ------- ... . ............. _ � ............. �� ' ro .. 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 onstruct and install the work herein described. This applIcatlo e ' com lia�cq,*th ina 54 xisting Rules and Regulations. �J"v ; /333 JOB ADDRESS/LOCATI N �. -[:- t_tk�_,4 ,.CENSUS TRACT ------_.................. Owner's Name Phone . ...................................... .. (1 Address .. � ..i`-a-c-R'_.� � .._._. .......... Cit � ,.�=�.� ................................. Contractor's Name : ,�rV,.l Oz_ -.License # .�N� 3z(27' - -� - - _ _ __. Phone .............................. Installation will serve: Residence ❑Apartment House❑ Commercial ®frailer Court ❑ Motel ❑Other Number of living units: Number of bedrooms _..—:---Garbage Grinder . lot Size h6'_z__/.C_U................... Water Supply: Public System and name __ ._. ..._ _. _ Private ❑ ------...---•---- Character of soil to a depth of 3 feet: Sand D Silt❑ Clay ❑ Peat❑ Sandy Loam [f Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material _._ 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 j-f Size._`'�1 Liquid D /� fir.-. .__ epth ...7......_ 01 Capacity t> _ Type cx MateriaL��ti^ti .-_ No. Compartments =a?-..-. Distance to nearest: Well _ .f! .......... L 0 ---- Prop. Line . C LEACHING LINE No. of Lines f . Length of each line -P `r Total Length r.--.-. Box Type Filter Material . . S,ti .....Depth Filter Material _.. f.y."-.--.-- Distance to nearest: Well _-1_C.- Foundation 1c?....._ __- Property line .............. SEEPAGE PIT ftf Depth -;2, .�- Diameter _.`.`.. Number f Rock Filled Yes No [� Water Table Depth �Z� _ J0,0_-------------------------Rock Size _..�7_.J Distance to nearest: Well . -----1. --- - _Foundation ... Prop. line ...... .............. I REPAIR/ADDITION(Prev. Sanitation Permit# ... Date _...._.. .. .� Septic Tank (Specify Requirements) - Disposal Field (Specify Requirements) .. _..... �. (Draw existing and required addition on reverse side) 1 hereby certify that 1 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. Home 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 . Owner y► 8Y �_ c s e. Title (If other than owner) - --FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - BUILDING PERMIT ISSUED - -- DATE . ADDITIONAL COMMENTS _._ _ DATE -- - ............... Final In by _.. c.z...,.:.., ------- -----Date -91/6 SAN'JOAQUIN LOCAL HEALTH DISTRICT E. H. 1-3 241-'b8 Rev. 5M 1 1 7/723 .4