75-613 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complett In Triplicate) Permit No. S .�. ./..J This Permit Expires 1 Year From Dote Issued �' S `.. ...................... 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 made in compliance with County Ordinance No/549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ,� .... ----• .....CENSUS TRACT ................ Owner's Name ................ ........ 112 .E _.. ..City _ .�. Contractor's Name -------------- __..L€cense ---•-- r •--------..f•...- ...----.. one --•----•-••-•-•-•----•••-..... -installation will serve: Residence Apartment Housel[3 Commerc€al❑Trailer Court 0 Mptel❑Other............................. Number of,living units::....(__.--- Nu'rnber �o bedrooms -.- Garbage Grinder Lot Si F ..... Water Supply: Public System and name I -._.......__ --•- J i .,�,,. •----••--,..._..._---...--••----•-----•- -•-•- ....Pr€vats Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan 01,, AdobeFill Material ...__....... if yes, ZYpe (Plot plan, showing\size lof lot, location of system•'In relation to wells, buildings, etc. must be placed on reverse side.[ NEW INSTALLATION: (No septic tank or seepage pit A mitted if public sewer Is available within 200 feet,) PACKAGE-TREATMENT-- Y [=J SEPTIC TAMC 7 *'Size........................... ................... Uquid Depth Capacity .................... T .. Material----=......... No. Compartments J Ype Distance to nearest. Well t ' � Foundation .......... Prop. Line _ LEACHING LINE [ j No. of Lanes ,, ........ p "x - 9 .................... ..•••••. ---- ._ Length of each`Nilnw,.. tTbtall en th � r I' V Box ..._.....__. Type Filter Moterial....?* Depth Filter Material �_. i ..\.pth -i' --•............................... n' Distance to nearest.. Well .............. ....r*Foundation .._._�-. -.-..•. 1 property Line ' SEEPA�G PIT 1 I •....................... ! I3epth ^_..._.,----•-,-. D€o�eter-- --*--=:.:.Number---._ - _.,i�� Rack Filled Yes ❑ No ❑%P it Lr r' Water Ta a Dep h -•-•••. )` �+� 'Rock Size I ) ---•----•..._..... Distance to nearest.• Well � ;�- L Foundation........I- : .,.._,.�_ Prop. Lina REPAIR/ADDITION(Prev..Sanitation Permit -- pate � � jJ .. . ------------------------------- Se`ptic Tank (Specify Requirements) . .._J_. Disposal Field (Specif I Requirements) .._. --------- ................. ---------------------------------••----..----•---------....-----------------•-••--------- ------------•-............ •------------- ------ -•.....I...-•--•....•-• ..................•.......... (Draw existing and required addition on reverse side) I herby certify that I hive prepares) this application and that the work will be de In accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health:DE riot. Hattie owner or llken- sed agents signature certifies the following: "I testify that in the per#ormance of the work for which this permit is Issued, 1 shall not et�i la an as to become subject to Workman's Compensation laws of California." p y y person in such manner Signed------------ • ---• ----------- -•-- -• _ Owner . . . ...... . ........ ;._.. Title --- (If of er owner) ... ........................................... FOR DEPARTMENT USE O L_Y APPLICATION ACCEPTED BY _.._'_. .;. BUILDING PERMIT ISSUED ----------- . DATE,.-$.---4 --' _.................... -------- •--...----------------- --------------- -..-----DATE ---- ADDITIONAL COMMENTS ----•------------------------------ ---••.. . ........... . � • --••----••----• ------._..-•----•-•--- -..._. _. -•--------------- --•---• ------• ----.-._._...._.--------..:__... --.._------._.-.------- --------------------•----••--•------------------------ ----------- Final ------------------------------------------- Inspection b • --- ---•----------•---•- -- ... p Y� -•-------•------- -- -•• - -•-- --•---- -�• -•---- .. .. . .. . ............Date -- � ---- ./`� EH 13 2L 1-58 Rev. 5 �/ .__.. SAN JOAQUIN LOCAL EALTH DISTRICT 8/7h 3M i