77-114 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT € (Com leteln Triplicate) y"`"t— Permit No. .•.. ....................•--- P . _... ...............................................:......... This Pemtltfxpires Z 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 Regulationse JOB ADDRESS LOCATION ...............-- ......................CENSLS TRACT I ` .. -_. •. .. - . .,... , -- .... Owner's Name ....... ._ .............. } .Phone ` 2.pq6 ? Address ............. City ................ Contractor's Name _..� •---•............... ....License ill ...... Phone . 5!6 4 0 7 Installation will serve: Residence❑Apartment House 10 Commercial []Trailer Court M-' Motel ` }x , ❑Other......_... .......................... f A, Number of living units—A.... Number of bedrooms ..........._Garbs a Grinder :..: Lot Size :.�©, ?.. y Z-0v :.. Water Supply: Public System and name ....................................................... .................. Private ❑ Character of soil to a depth of 3 feet. Sand❑ Silt❑ Clay E3"Peat❑ Sandy Loam [] Clay Loam ❑ 4crdpan 0 Adobe Fill Material..................If yes,type ............. .............. (Plot plan;showing size of lot, location of;system in relation to-wells,-buildings;-etc.must be placed an reverse side.) NEW INSTALLATION: (No,septic tank orlseepage,pit-permitted if public sewer is available within 200 feet,) it j PACKAGE TREATMENT ( ] SEPTIC.TANK ij Size...................... Liquid Depth .....--- ................. Capacity.-- Type,,:-.._:i.............. Material...................... No. Compartments ky Distance to; nearest: WeTI ............... _:F6undation' �................ 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 ........................ SEEPAGE PIT � �`� � - ,., E PIT [ ! Depth ..4-.._._- Diameter Number Filled Yes ❑ No ❑ ._...--•---•---- ............................ Rock I Water Table Depth ..__ Rock Size ................................ Distance to nearest: Will ....................... ... oundation ....'............... r Prop. Line ...................... iEPAIR/ADDITION IPrev. Sanitation Permit# --------- Date ................... T : Septic Tank (Specify Requirements., :......----•---------.----•---------------------•-�:•--•-•------...---�•------._......-......-------•---..._.....__...._..........----,.,.0 a 1 ✓►'�_ �._._.....r�Gr� ycF �X 2-5 �."a r r Disposal Field (Specify Requirementsl �-.. ..._... _"Y'^":'. �. .:.. 4 ................ ------------------------------- - ----------------------•-•-•--�--•-----.............••--•---•--- .--.-. _---=-----__._.......--:._.._._.____...._\.._..__....=...............................- ................. _ (Draw existing and required addition on reverse side) `' I hereby certify that 1 have prepared this application and that the work will be donne in atierdance with Son Joaquin County Ordinances, State Laws, and Rules slid #Regulatlens of the' an Joaquin Local Health,District.'Home owner or liatt- sed agents signature certifies the following: "I certify that in the performance.of the work for"which this perm issued, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed ------------- ---•--------------••---------------•- ------ Owner gY _ other than owner) •.,fORYDEPARTMENt:USE ONLY -A APPLICATION ACCEPTED BY __ ---_ -- DATE ILI]ING PERMIT ISSUED ,.--------- _ DATE --.-----...... .._._ ADDITIONAL COMMENTS ...............•----•-----....----___-- ------------------ ...- -•---:- ------•-----------------•--------- __.._.-----.._......----....------...-- ......----.............. . ._.._--- . ......................... j• Final Inspection by: •-------•---- -- ? .........................•---...Date ISI 1. ....�.--r.7��......... .... $ 3 .2h I-68 Rev. 5� SAN JOAQUiN LOCAL HEALTHDISTRICT 8/7h 3M � l