76-855 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ................................... .................. � .. {Complete in Triplicate) . Permit No. ..- �.S` ... . p .................................... . ........... This Permit Expires 1 Year from D 1 Date Issued ._x.......76 Daft Issued 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 Regulations: JOB ADDRESS/LOCATION ..•2.Q...�..�---� ......CElVStJS TRACT Owner's Name ................. `rZ'P.. ! .....................•.........._... ............---------Phone -------- Address ............................ .................. ..... --- ..--•---......City .. st rf- ..........................•--..................... Contractor's Name �`�. ' 4�+nr?4 rirw-... ...------..License # ................................--- Phare ------------ --------------- Installation will serve: Residence Apartment House Commercial QTraller Court jj g umber of bedrooms ' Garb Gri_der Motel(]Other......................�-. Number of linin units -•-� N 'oder ...- __-•-. Lot 5 ©..-_- ....................... Water Supply: Public System and name ...................................w......... ._.. .t. �._ - ......................Private❑. Character of soil to a depth of 3 feet: Sand b Silt❑ Clay ❑ Pea Q Sandy Loam 0 pay loam 1 Hardpan p Adobe1A I-iii Matertai ......... If yes,type............... ............ (Plot plan, showing size of lot, location of system in relation to wells,-builclings, 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; ) Size................... ..... Liquid Depth ..................... Capacity -----------•---•---- Type ..............:..... Material....................... No. Compartments ...................... Distance to nearest: Well ....................................Foundation ...................... Prop. Line................�..,.� LEACHING LINE [ No. of Lines --------------------- Length of each line............................ Total length ---.---------............... � 'D' Box .._.._.._... Type .Filter Material ....................Depth Filter Material ................................____........ Distance to nearest: Well ........................ Foundation..........-�......._.:.... Property line .._......._..._.........� SEEP PIT [ ! Depth .......... ......... l}iameter �---•---•-__.... Number ..._.....--:'........... Rack Filled Yes ❑ No Q E Water Table Depth ..........................::...................Rock Size Distance to nearest: Well ........................................Foundation ------._............ Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation. Permit# ....r.........:......................... Date ...................................) Septic Tank {Specify Requirements) _ _XL ..................... ......................... ._..................................................... Disposal Field (Sp cify Re uireme s} Y "`` 17 ------•..........__ l c -- - .... ----- ................ ••-•------------•-••---------------- ........................ --------------------••---- ............................. ---••-------••---.. ................................ (Draw existing and required addition on reverse side) I 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:Dlstrlct. Hance 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 ublect to kman's Compe sa#ion laws 4f California." Signed .......... � .... ......... . ............ .. ........... Owner BY -•-•------- . Title (if other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ..7---- DATE -- ,l.7�.._ �------_-BUILDING PERMIT ISSUED -- -- •-•----------- DATE ....... .. ADDITIONALCOMMENTS -... -------------- ----------------------•--.--__...-. ------------------------------ -•-.•----........_•--.-----•-••---•---------•---- ,...., -- -- ----------------------•------•------- EH1 2 tion by: ---'_.._.._ .. .. . -----•--- ---------------• ---------.._------- ._...-•--------•• - I final inspection by: -- ------- -•--•• ................ ...........Date .... .. __ .. . . . .. ' �• SAN JOAQUIN LOCAL HEALTH DISTRICT 8 7�t 3M