74-415 - Laserfiche WebLink

Home Browse Search

a FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. .77. �5... .......................................... .. -_y.- ....................................................... 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 described. This application is mode in compliance with County Ordinance No. 549 and existing Rules and Regulations: 308 ADDRESS/LOCATlO z .r ,. �� .CENSUS TRACT ....-.:::.::.::....._..... .......................:.' Owner's Name .... .. . .�.. •-••--- Phone Address ..... :/� .`� .�:'... :.... ................. _:! .. City ........ . ....- :................ k ... Contractor's Name ....... fom �_ .. . .... ................... Installation will serve: Residence Apartment House] Commercial ❑Trailer Court 0 Motel ❑Other ............. Number of living units:.... ..... Number of bedrooms ........Garbage.Grinder ._..._...... Lot Size . -4 -a ------------- Water Supply: Public System and name .......................................... .......•----•----------•------ ---------.-------___---------------------•--•-•-........ Private Character of soil to a depth of 3 feet: Sand n Silt❑ Clay eat❑ Sandy Loam 0 ' Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Materia( .::.':...... If yes.type __________________________ (Plot plan, showing siie of lot, location ofsystem in relation`•to�wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage 'pit permitted if public sewer'ls available within 200 feet,J , PACKAGE TREATMENT [ ] SEPTIC TANK ) Size................................................__ Liquid Depth ...................... Capacity _ Type ... Material.................. No. Compartments. . ..Distance to nearest: Well ....................................Foundation ...................... Prop. Line ...................... LEACHING LINE [ ] No. ofline_s ------------------------ Length of each line.....................-....... Total length ............................. 'D' Box ........... Type Filter Material ...:...:.::.::.......Depth Filter Material ._____._______.___.__...._....... ........ a Distance to nearest: Well ................... Foundation ........................ Property Line ............:........... SEEPAGE PIT [ ) Depth ................ .. .Diameter ................ .Number ............................ Rock Filled Yes ❑ No [J Water Table Depth .................Rock Size Distance to nearest: Well --......................................Foundation -................... Prop. Line........................ REPAIR/ADDITION(Prey. Sanitation Permit qlE ..... Date ................................... Septic Tank (Specify Requirements) -------------------...---------------... ............•----•..._...... ........_..� Disposal Field Specify Requirements) ... ..... ...... ......... ............ ................. c ----- -• `�"f - `�" .�_...-'!X z s ................... ------------------------------------- (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 District. Home 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 subject to Workman's ompensation laws of California." Signed ...................................... Owner . . -...0: .:_...-- •-- •--....... r- By .............................. •--•-----•---•-• •- 3itle .._ �............... .-------- (If other than own r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ..--- --------•------ . ... ... DATE _ J.T/-7`-� BUILDINGPERMIT ISSUED .........................•------------=-----......-----.....:_..------.._._::_.-------------•--•-••---....DATE .................................---•-••- ADDITIONALCOMMENTS ...................I...........: ..................................... ................. -----------• = -•---- ----------------- -- Fina( Inspection by: ..�. �r -s ---:..--- - Date. 1/.................. ................................... --'•j •` ...-. ......... _ SAN JOAQUIN LOCAL HEALTH DISTRICT E. H.13 24 3-'68 Rev.5M_ 7/72 3 M