76-291 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION ICOR SANITATION PERMIT ..................................._............... l d —� / (Complete in Tripilcate) Permit Na. ..7................5... Date Issued .. ..----- ....................I....................•._........... . This Permit Expires I# Year From Date 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 ca liance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCA l �,1--�... . ..................................................CENSUS TRACT `.------------- ...._ Owner's Name ......... r 1 7- 6.47.. A . . ............. ...... Phone _.. AddressCity --)61K �Z...................... ................................. Contractor's Name --_!U-�a�-- -- ta - .......License # ........................ Phone Installation will serve: Residence Apartment House Commercial❑'frailer Court ❑ Motel ❑Other.......... ............................. Number f Irvin units•...1 Number of bedrooms Garbage Grinder ° g ---•--- ._ ._..._. ............ Lot S Water Supply: Public System and name ......................................... Private ❑ Character of soil to a depth of 3 feet: Sand❑ Silt 13 Clay ❑ Peat Ef Sandy Loom 0 Clay Loam 2 _ Hardpan❑ Adobe 5L Fill Material ._...... ... If yes,type............... ............ (Plot plan, showing size of lot, 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 204 feet,) PACKAGE TREATMENT ( ] SEPTIC TANK ] Size-------------_----..-----_._._._..._.-- Liquid Depth Capacity ------------_- --- Type .................... Material...................... No. Compartments ...................... Distance to nearest: Well ............... .....---Foundation .-................_... Prop. Line ...................... LEACHING UNE [ ] No. of Lines ----. --_------------- Length of each line........................ Total Length .... ........................00 'D' Box ............ Type Filter Material ....................Depth Filter Material ............................................ Distance to nearest: Well ........................ Foundation ..._........_.... ...... Property Line _....................... JA SEEPAGE PIT [ ] Depth --------------_--- Diameter ................ Number ---------------------------- Kock Filled Yes ❑ No ❑P Water Table Depth .......-:.--• ........Rock Size Distance to nearest: Well ............................. .::.......Foundation ..........__........ Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date .................................. ) Septic Tank (Specify Requirements) " .a -- .......,p. -------•--...---� ....--- Q - ---------------------- ......_..._.. Dis oral Fielq (Specify Requir rnents) .... .. ..... �4....----- --- - -- Y_� �J - -- - ------- ----------•-_........................................................ L{ P (Draw exi Ing a 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.District. Home owner or llcen- 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 bec70-1 ubject t kman"s Compensatl low V!! fornia." Signed .... .. ..., .yi---- By ------------------ ---------------------- --------------...... Title t Z' (if other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---- - ------ - - .... .................................•--- ---------- ------. ----.. DATE �!-.7.G. 13UILDIAIG PERMIT ISSUED -- --- -- ....................---------------DATE ....... ....... ---------_.......... ADDITIONALCOMMENTS �W... - �� ,----------- -------------•--••-•--...... ---. ...................................... ----------------------•------------- _..... ---------------------------------- ....--•--------------------------------- ...------------------------------------ -----------•- --------... -• --••----------------- Final Inspection bY- -----------------•------ •-•----........-•---.......................-Date -~....... ................ 13 �'a "6 v• SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M