76-653 - Laserfiche WebLink

Home Browse Search

yf V+ra u srr1Y.lC ALJ. : ,� r...... APPLICATION FOR SANITATION PERMIT ,74_ C I ....................................................... (Complot*in Triplicate) Permit No. ................ , This Permit Expires 1 1,.:''� Asn Date lssued Date Issued :.lT.�, � 5 Application Is hereby made to the San Joaquin Local Health Diatrlct fora 7 76 described. This application Is made In compliance with our Ordinance No. 549 and existing and ainstandthe Regulations,herein ,r JOB ADDRE 145-0 2— U SS/LOCATION .... Owner's Nome .... .......... .. ..............................................................CENSUS TRACT .. Address ... x .. Phare . :. Ln..'-,�.. .� . ... •-•-- -- . � .............City . Contractor's Name . ,� ................ ..... `t ------ •---•-•-•---...--•......................Licensee 7 � _. Phone . Installation will serve: esidence®'Apartment House Commercial[]Trailer Court D Motel❑Other -..._ Number of living units:------------ Number of bedrooms - Garbage Grinder Lotize Water Supply: Public System and name ..............................._..._ - ---------------�._....._..........._....S ........................................••-...Private.......--..------- � ®— 7 Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat(] Sandy Loam ❑ day Loam Hardpan© Adobe❑ Fill Material ............If yes type............... ..........0 (Plot plan, showing size of lot, location of system In refat€on to wells, Y buildings, etc. moat be placed an reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK; j Capacity I�-dDSize................................................ j . ��t Liquid Depth ........................ YPe Material.. No. Compartments arfinents Distance to nearest: Well .40fe. -----------Foundation . .. Prop. Line i LEACHING LINE [ ) o. of Lines ............... • _ ��, --- ......... N - --- Length of each Iine..7D-.-- � t".`�atal�Length .�1a r .� 'D' Box . --------- Type fitter Material Depth Filter Material .2- r. ' �E • . Distance to nearest: Well ............... Foundation Found .. .... .............,..-----••--•-- i atlon .................:.... Property Line .._. . .................... ...SEEPAGPIT Depth ...... ............. If Diameter _.._......_..._. Number ....:._ Rock filled Yes ❑ No Water Table Depth .................................................Rock Size .............. Distance to nearest: Well ........................................foundationProp. )Ina ................... REPAIR/ADDITION(Prov. Sanitation P ermit . Date Septic Tank (Specify Requirements) ............................................................ -----,........ .w.................. .. i Disposal Field (Specify Requirements) ........ ....- -- ....._._......_...__........ ......... ............ i • ................. ...........---• . .-•_ ................. J ............................................ ....... ..........._........ - ....-----• prepared _.. o...............•-•-•--••••••--.........--•.................. raw existing and required addition on reverse side) 1 hereby Certify that I have re ared this application and that the work will be done In accordance with Son Joaquin y County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or lice 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 Compensation laws of California." Signed ... •�,� �J -•- Owner By ............... • . --....--- . Title ..... n ............................ (If other.thim owner) ----------------------- -----...-............ y {� ...;!t� FO DEPARTMENT USE ONLY _ APPLICATION ACCEPTED BY BUILDING PERMIT' ISSUED DATE 7``...��..� ..... .......... ....DATi: ADDITIONAL' COMMENTS --- ............ ................."---•-•-•"- .................... ...................... ...........- .................... . ... ............................ ............................................................................................ . ..... Finallns esti .... ....... IHC 13 24 1-613 v. ................................... Date ... .. __ SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3rd