75-976 - Laserfiche WebLink

Home Browse Search

A FOR OFFICE USE: ; f� APPLICATION FOR SANITAiiON PERMif •-•---•... ................. . 7s 976 (Complete in Triplicate) Permit No. d I Date Issued ............ -_...-.-- This Permit Expires f Year From Date kiusd Da ........ 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. 549 and 'existing Rules and Regulations: JOB ADDRESS/LOCATION S.....pL._1... - -.. ..----- �_-.... ...... .........CENSUS TRACT .................:.:..::._ Owner's Name .. ...... r �.._,..._. ._.. Phone .................................... Address C7. •,a_...._ Y i 1. �.,•�• . Cit Contractor's Narr+e / Phone � a . � License tP`c Installation will serve: ResidenceAApartment House-0 Commercial [)'frailer Court C] Motel 0 Other ......... _-. .-- ----•- - I Number of living units:.. ..... Number of Brooms -_. _._Gorboge Grinder � - Lot Size ..../_4 Water Supply. Public System and nameprivate Character of soil to a depth of 3 feet: Sand 0Sift❑ Clay [) Peat j] Sandy Loan [ Clay Loam E] Hardpan ❑ Adobe 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.{ 4 NEW INSTALLATION: {No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK j ] �^ / S -- ----------------- ---_ Liquid Depth .- -_.:_--_• Capacity - . Type ......--•........... Material---...... -No. Compartments v� Distance to nearest: Well ..._._..._--__-.--.Foundation ............. ....... Prop. Line ..._.__....- 1 NE ( ° No. of Lines _ - Length of a ch I' a ..: --- LEACHING LINE � r ....... Total Total Length -��.................. 'D' Sox _.-~- - Type Filter Material �p,' E •��s�l-�-•---Depth Filter Material .... Distonce to nearest: Well ..47V.............. _ .., --Foundati n � ...---. Property Line SEEPAGE PIT - _�'.r............. De thCNumber � ...... ......:..... Rock Filled Yes �kl No i(] Water Table Depth �.. ....... ----------------_---Rock Size ...fi . - -._- - Foundatio f Distance to nearest: Well ./Q�-- ------------------ n ..., �f_...... Prop. Line ---r ._._._......__. REPAIR/ADDITION(Prev. Sanitation Permit# .................... Date ---------------•-:._..----_--• �` Septic Tank {Specify Requirements) _ _...................... Disposal Field (Specify Requirements) _.. a r . -------------- ----------- ........................... (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 Leval H"Ith District, Horne 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 stroll not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed - - --------- --- •- Owner By .. . __... ... .._ . . !-� - Title - F/ ....-•--........ . .. . ...... .. (I other than owner) FORDEPARTMENT SE ONLY APPLICATION ACCEPTED BY .. BUILDING PERMIT ISSUED ....- _....- ....... ADDITIONAL COMMENTS ... .........._... • -------DATE . ...................... --- - - - - ...._.-... �� ---- --- -- ....- ----- --• ----•- --_..-. Ina Inspection by- -- - ------- --- - _ ._. Date ....47. SAN JOA IN LOCAL HEALTH DISTRICT