76-1000 - Laserfiche WebLink

Home Browse Search

_ FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT �'�// ......... .... ......................:.. .. . Permit NoZ:7 - (Complete In Triplicate) . ........... .........................................', This PerrnitExpires t Year From Dot*Issued Date Issued Application is hereby mode 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 Regulations: i. SS/LOCATON .. r ..........CENSUS TRACT-__........... ........JOB ADDRE .... Owner's Name _...-_. . - • ..Phone ............ . ........® -- __ . .. ............... CIty .....Address ................ l . .................. ........... Contractor's Name ............ .. - License # 07 ��... Phone ..._.._.... -••------•--- _ installation will serve: ' `' ResidencetqApartment House f3 Commercial❑Trailer Court 0 Motel❑Other............................................ f Number of living units:...... Number of bedrooms _._,2�--.....Garbage Grinder ............ Lot Size .... ?-..�"� ✓............ Water Supply: Public System and name;............................................ :-•-•-•--•-----=--•----•--.--......................................Private (� Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ ^ Peat❑ Sandy Loam 0 Clay Loam ❑ Hardpan Q Adobe❑ FIII Material ............ If yes, type, ............. ............ (Plot pian, showing size of lot, location of`:system in relation to wells, bulldln&r, etc. must be placed on reverse side.) t NEW INSTALLATION: (No septic tank or seepage .pit ,permitted if,pubilviewer is available within 200 feet,J S { ] ....... Liquid Depth ' PACKAGE TREATMENT; SEPTIC TANK -` Size...�,� r.1�.d'..................... r Capacity _ _ . nn ?f TYPe li. ---- Material_,�:. .:No. Compartments ..................... Distance to nearest: Well ------- v---t .............:.I"aundation ...�1 .............. Prop. Line ...ate--............. LEACHING LINE Cj No, of Lines ______Z_ Length of each line.__._ .... ...... Total Length ..17-Q................. trc D' Box ------------ Type Filter Materal ..1�- _.._Depth Fllter.Material ...... ...............................tom Distance to nearest; Well ....4' ... ...... Foundation ---..fi :...'f' . Property Line SEEPAGE PIT Depth ---- - -------- Diameter �' p Number .....Z........ ........ Rock Filled Yes No �❑ r Water Table Depth --:------__ -- - ..............Rock Size�.- Distance to nearest: Well .......................Foundation ___A ._ ..... Prop. line ....5.. ...... ;7 REPAIR/ADDITION(Prey. Sanitation Permit# .....................:..............:..: ... Date=-........................... ) 9r Septic Tank (Specify Requirements). - --------._•.............:................•---.......-•----.•. ................................................................ ......:.. Disposal Field (Specify Requirements)—_., ._,_--------------------- ..............................._.......,-__.._............... ....... .. ---•---.....•--------------•---•-......... (Draw existing and required addition on reverse side) I 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 !tales an'd�Regulations of-the San .Joaquin Local Health.flistrid. Home owner or lieen- sed agents signature certifies the following: ( "I certify that in the performance of the work for'which this permit is issued, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed -------- - --- ----- ---- --- --------- -• ---------••----•-•.- _- ----•----- Owner BY - ...................... lif other owner - - Title ,..-._.-..- DEPAIt7MENT USE ONLY APPLICATION ACCEPTED BY . -----. DATE /- _ - --7 -r�- ...........:.:_ BUILDING PERMIT ISSUED -.-_-- - -------•--------------�....-•---•-•------------------ ....-----------•---------•----DATE ......................................... ADDITIONALCOMMENTS -------------------------------------------------------- ...................---------- --•- • ••-------- •=---•---- ......................... - ----------------------- -••-------------•••--- ------- -----...------...............................•................ ... •----------------------••• --- �. ...... ------ ----- __•---•--- --------- Final inspectiony: ... _._....... Date 1.. -.. :: --------- 13 21a6v• SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M