76-308 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ....................I...............---•--.. . . .... Permit No. . �G•-3a (Complete in Triplicate) _ .. .. ...... .........---•-.•..-••-.--............-.... � � ................ This Permit Expires I 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 1 described. This application is made In compliance wi h County Ordinance No. 54 and existing, Rules an A gulations+ �f f J��yn W/Y JOB ADDRESS/LOCATION .---�-�Ca �o ! ... ............ ............CENSWS TRA ��'�>•c Owner's Nam �Ft....... �... •• . .. . .......-•-- Phone ` p ............... ---------- Addres ..._-....... :.0 .c- ...45 ?K---L .<. ••... •- City Contractor's Name . ti ` License # - . Phone -------------------- Installation will serve: Residence[`Apartment House Commercial OTrailer Court 0 Motel.[]Other--. •----•-•--••--•--------------- Number of living units-------F.--- Number of bedrooms ...........-Garbage Grinder ------------ Lot Size ... ______________ _ +---- Water Supply: Public System and name ....Private i Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay .a Peat❑ Sandy:Loam ❑ Clay Loam Hardpan C] Adobe❑ fill Material ....... .... If yes,type ............... ............ (Plot plan, showing size of sot, 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 I cpwipatosize'.O6 «el__'j41X_- ...... Liquid Depth -------_-_----_----.----_ Capacity -------------------- Type -------------------- Material--------- ------ No. Compartments -_---.-------------g• Distance to nearest: Well ------------------------------------Foundation ----------------- .... Prop. Line ......--____-____-_W LEACHING LINE [ l No. of Lines _- --.... Length of each line-_------------------------ Total Length _.--..._-_•----___.........� 'D' Box ..�------.`_ Type Filter Material ____________________Depth .Filter Material •--•.............................._......... �. - Foundation per Line k Distance to nearest: Well ---------------- -•- --------...._..-......_. Property ........................ SEEPAGE PIT [ 1 Depth -- i_______________ Diameter =-__..__--__._ Number .....................-...... Rock Filled Yes ❑ No C1 fWater Table Depth ---- ------------------------ ---Rock Size -_--_------------------- Distance to nearest: Well ----------------•-----------------.-----Foundation ...........----...-- Prop. Line .................... I - Date -------- ) REPAIR/ADDITION(Prev. Sanitation Permit I to Septic Tank ISpecify Requirements) ------- ...........1........................•-----....--•-....-•...... .......... r r� .�-•rte?.. -----�..... ........ Disposal Field {Specify Requirement }__-• -• t ./ ` r f0Q � - 9 / ........ - . ... _........._ - 00 a � - ��--- --------- ....... ........... ... Or—[Mw existing and required ad ition on reverse side) I herebycern that I have.i repared this application and that the work will be done in accordance with Son Joaquin certify p 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 erformance of the work for which this permit is issued, I shall not employ any person In such manner as to be me sub's #o orkman's Co pensa#ion la of California." Signed --- .-..-�.... ....... ... ...• �•- --•---•--- BYtitle ---• --------------- ------------- (if other than owner) FW DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ... - -•- ---....._.--....--------------------•----- -.. jDATE._7 -.�. BUILDING PERMIT ISSUED ...... ................... TE - .----------•-------- ........ 4 ADDITIONAL COMMENTS !/�-�Oa. .... .--•---... ---- ----------•--------4---------•._.-•------------ ------ ---- ----•- ......... ............ ----------------------------------------- ------------------------ - -- ....f.... '-. ---....... --.._-.-...-..----_.•....------......-•--.-.----...--...__._•------------..-. ----- --- ._-.... Date _-.. •- - - ......._.... Final Inspection b • EH 13 24 J_-6£i Rev. I SAN JOAQUIN LOCAL HEALTH DISTRICT /7h 3H