75-182 - Laserfiche WebLink

Home Browse Search

FOR OFFICE U.SE- APPLICATION FOR SANITATION PERMIT .................................. ........... (Complete in Triplicate) Permit No. .:7 .-.�. .� ........................:_............ ........... This Permit Expires 1 Year From Date Issued Date Issued I 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. 49 and existing Rules and Regulations: JOB ADDRESS/LOCA? N,��_. ��.:c://�I. Q-.• '.: Pte_ Gt'r:-.:-.:. . :: -CENSUS,TRACT ......::............ ... t - ' e s P .......Owner's Name � ess y��' �... _. . �L.l.. ......:. Cit,y - -•... -•----..._ Addr . _. .._ ..Lie -;.. •--- Contractor's Nome . ......... ---'. ............ ...----' ---'.. ense # :.._...:......:.._...... Phone .. .. .... Installation will serve: Residence 0 Apartment House' Commercial ❑Troller Court dr � F Motel� then � I Number of-living units:...._.... Number of bedrooms .- :_.-_-Garbage-Grinder .._._:....._ Lot Size ----.----_--------------- Water -.............. ......Water Supply: Public System and name ...:. --------- •--- -- ------ " ------•---- ----•.Private ❑ i t Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑. S aHardpon C] :Adobe ❑ Fill McIterialIf ye ,tYPes ---=' -" . l (Plot plan, showing size 'of lot, location of system ini, 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 200 feet,) PACKAGE TREATMENT '• ) SEPTIC TANK-T I : Size............:..::.. .•_ ........ .,.: ;- liquid. Depth .... Capacity ` --'Type ---- Material .... ....... No. Compartments; �....:,... �D i Distance to nearest: Well = • 'Foundation - - _.._>_. ..._.... Prop. Line ................. i LEACHING LINE [ ] No.• of Lines : ..... ... ..:... Length of each line .------- .._..:..Total Length .. 3.. 'D' Box Type ;f=ilter Mdteriol .- ------------ ...Depth Filter Material : ..... Property Line .............. Distance to nearest: Well . ........ .., Foundation ... ._._: .. k SEEPAGE PIT _[-�w Depth R Dia mefer; T T. Number _. Rock Filled Yes ❑ No [] Water' Table Depth _-- ---Rock Size ------ I fi Distance to nearest_ Well ---__-_-- Foundation -.- ' Prop. Line.... .............. REPAIR/ADDITION(Prev. Sanit fatiori Permit# M .... : :___ ate :. ) t � Septic Tank (Specify Requirements) � ^ Y - Disposal Field '(Specify Requirements)' -------•---:----s`-'- v.:� ---.-.- C f . ...... . r. .....".�------------- l = ------------------- ...... --- . ................. .........'................................. :...... : _ ` . .,....... . .. . ... ..---- (Drdw 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 iic*h- sed agents signature certifies the following: ._ "I certify that in the performance of the work for which this permit is issued,,l shall not employ any'person'in such manner as to bec a subject to Workman s Cgmpensati n laws of California." Signed r4. ��' �� .-AA------------_.,_°Owner BY : Title : P� �: . . .--..... (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .................... .------..... ... ' ' DATE ........ ..._,...:. .. _..__. _. _ ..•._.., _._._..... _ . BUILDING PERMIT ISSUED ................... _............DATE : ' e ' ____. ADDITIONAL COMMENTS ..........................................-----------..............................:.................--------------.........._.._._._-_..._-..... _..._._, ................ Final Inspection b --.---Date ... ......-•-'----------------------_----- SAN JOAQUIN LOCAL HEALTH DISTRICT 13 24 7/7234_ 1-'88 ev. 5 _- F-