76-689 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: r APPLICATION FOR SANITATION PERMIT Permit No. 3 (Complete In Trlplicatel .... .... ............................................ :� ..... .........................................._. This Permit Expires 1 Year From Date 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 unty Ordinance No. 5A9 and existing Rules and Regulations: JOB ADDRESSAOCATIO ...- .�.. .CENSUS TRCA�CT Owner's Name ..... ................................ Phone . la........7..��........... ,. Fidciress .._............... .... ..... ...... J`' ' ---.. ........... ... ----..._.... City .... .. ......I ........... .. -- r .p_.`.... .... Contractor's Nasse • •-• ................'..... .... ....._U .......... license + � - Phone .`'_ ?.�l..K?.QZ.... Installation will serve: Residence K.Apartment House Commercial OTraller Court 0 Motel 0 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 Slit❑ Clay p Peat❑ Sandy Loom ❑ Clay Loam ❑ � Hardpan Adobe Fill Material ..:......... If yes,type............... ............ !Piot plan, showing size of lot, location of system In relation to wells, buildings, etc. must be placed on reverse sidt NEW INSTALLATION: (No septic tank or seepage pit,permitted if public sewer is available within 200 feet,l PACKAGE TREATMENT [ } SEPTIC TANK Size..........t. ...��.................... Liquid Depth . .. ............. Capacity .Ir. .. . SType . _.. Material._�, 7.6<.r... No. Compartments ............ ....� Distance -to nearest.• Well Z.Q. ._-__.._._...Foundation lL�..... Prop. Line _EACHING LINE } No. of.Lines -----,.�................ Length of a line.. .......... Total Length ..l ............. De • e `D''Box Type Filter Material ptfi Filter Material .....1 '..............................� fi -r - . Distance to nearest: Well ../..1c7..:........ Foundation .. ..la .a....... Property Line .I........... SEEPAGE PIT Depth :..` 1......... 'Diameter ... Number ._.._._�.._.. ..... Rock Filled Yes` ' No ._....-�� j /� r. Water Table.Depth -•-•.................... ..... .....---.Rock Size ..3. % .......... o x Distance to nearest: Well .......1... ........................Foundation .... .. ..... Prop. Line ....17 ....-....... -- REPAIR/ADDITION 1Prev. Sanitation-Permit ............ .Date ..:.:...:.........................y peptic Tank t5pe4ilfy Requirements) •-' ..............................................................•-........ .......-................... ..-.................. . ..... .. t � Disrsosal Field 1Specify Requirements) ............................................. ..."............................................................................. � F ......................................................................................._..---............._-•...................•.. ..................._...._..............._..••-•-----• - OLV (Draw existing and required addition on reverse side) F I hereby"certify that I have prepared this application and that the work will be done In accordance with San Joaquin County_Ordinances,�St_ate Laws, and Rules and Regulations of_ the.Son Joaquin Local Health District.Home owner or flan- sed agents signature certifies the following: i "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." -aned ...... ..... .......... .... ....... . . Owner �$........................................ .......... ..... Title .......:....... (l r than owned JFOk DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ...... ........ DATE .... ._. .. ...... ............... ... �..:........... BUILDING PERMIT ISSUED .........."' ....... .. ....................•---..................._.._.__ °. ._DATE.:�...........-_.._...---•---...... ADDITIONAL COMMENTS ..... ............ ............. ................. .......................................................... .-............................................. ... .-. . -... .... Date.---- Final Inspection by- ' _. ....... . ......... ... ........... FH 13 211 1-66 R©v. 5q4 SAN JOAQUIN LOCAL HEALTH DISTRICT 8/711 314