76-811 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: � 1...: .. APPLICATION FOR SANITATION PERMIT .. �i� . (Complete In Triplicate) Permit No. 7 .............. This Permit Expires 1.Year From Oche Issued Date Issued ._"�1: 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 Ordinance No. 549 and existing Rules and Regulotions; JOB ADDRESS/LOCATION ..1. ./ ... ...:�.f......... ...........CENSUS TRACT _ --------. ...... Owner's Name ............... .... --, ...:......... ..................Phone .��'347:O 7Z%r7_ Address ...................-��... . .?Z.�' ..... City .�.... • ....................: ---.... -•.-.--------- - . ' Contractor's Name ...... '-c ti`.. .. � .....Liosnse :�j 37:- - Phone Installation will serve: - Residence dAportment House 0 Commercial QTrailer Court 0 Motel Q Other •. ..:.- Number of living units ..... Number of bedrooms -Garbage Grinder ............ Lot Size Water Supply: Public System and name ..................................:... .. .--..Private . Character of soil to a depth of 3 feet: Sand 0 Silt d Clay 0 Peat Q Sandy Loam'0 Clay Loam Q Hardpan[] Adobe 0 Fill Material .. .........If yes,type........ ..:. (Plot plan, showing size of lot, location of system In relation to wells, buildings, etc. trust be placed an reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 240 feet,) PACKAGE TREATMENT ( ] SEPTIC"PANIC I I Sine . Liquid Depth... .......: Capacity ................. Type Material ........ No Compartments Distance to nearest: Well ...... ......... ...-....Foundation ...... . .............Prop. Line .......................� LEACHING LINE j l No. of Lines ..................... Length of each litre........................... Total Length J1 i.. V Box ... Type filter Material . ....... ..... .Depth filter Material . ........_.......... .._........-......... Distance to nearest: Well ................:....... Foundation ........................ Property Line ........................ Tn SEEPAGE PIT [ ) Depth f ........ Diameter Number hock Filled Yes Q No 0 . Water Table-Depth .....Rock Size v 4 Distance to nearest: Well ........................................Foundation .................... Prop. Line ..................... REPAIR/ADDITION(Prey. Sanitation Permit .. Date } Septic Tank (Specify Requirements).-•--•- -----•-•-- ......... Disposal Field (Specify.Requirements) r .. ..... ....- �.�,............................ ..,............ a------- .......... -• _... .. .......... -- ----------- C"".-`�---� ... ��CI - �� '"� _ :-� .......... . ........... .. ---••--• . ........... ........ . � ----•. ----- ------ (Draw existing and required ad 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 Health;District. Home owner or licen- sed agents signature certifies the following; "I certify that in the rformance of the work for which this permit is issued, I shalt not employ any person in such manner as to becog : sumect to Workman's Co ensation latis of California." Signed ...... a .............. e°ivo r BY •------ --------•- --------- ----------- -- ............ Title : .. to - - .-., ••--.:.... (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION.ACCEPTED BY ------ ........ ................ - ..................... DATE _._.._. : �1... �--._....... BUILDING PERMIT ISSUED .....,_:_e.------_.. . ........DATE ...._............. . ADDITIONAL COMMENTS ..... ..... ..:............... . ....-•••-...._............................ ................._._....._..............._. .......•... ............ .......................... ---.......... - ------ -- ----- -------------- final Inspection by ----- --- ....-•-•-•..................... . .. ....... :...Date _.... ,/- :/� .. EH 13 24 1--68 Re . SAN JOAQUIN LOCAL WEALTH DISTRICT s/?�i_ 3M 'i,