75-356 - Laserfiche WebLink

Home Browse Search

"-FOR OFFICE USE: F APPLICATION FOR SANITATION PERMIT -- ��-- -------------- - ----------------•--- Permit No: �_'�_~?,S--- ------------- •S_ (Complete in Triplicate) ------------- _ ________________________________._---____-__________ This Permit Expires 1 Year From bate Issued Date Issued Application is hereby made�ft_'o'the Sari J aquin Local Health District for a permit to construct'and install the work herein described. This application is made m com lidnce-wit County Ordinance No.r549 and existing Rules and Regulations: �! 4 JOB ADDRESSAOCATIO 6 -- -�_— ------- ---------------------- �D 7 = ---CENSUS TRACT --------------- ---------- Owner's Name ------ --- = ---------- Phone�J _ _ b_ _ . Address --------------------=----- l - City ------------ -----------------------------•---------- C i Contractor's Name Jn-'a�1-------- License #ooP0_ _ Phone `fK447 j Installation will serve: Residence Apartment House❑ Commercial ❑Trailer Court i❑ Motel ❑Other ------------------------------------------- If Number of living units:__- _--_--- Number of bedrooms Garbage Grinder __________ of Size ----� __ _-____-__-- Water Supply: Public System and name ------------------------------------------------------------------------- f _ s f -----------Private ❑ 4 Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay 0 Peat❑ Sandy Loam 'E] Clay Loam ❑ IHardpan ❑ Adobe Fill Material ------------If-yes,type -_________________________ (Plotplan, showing size of lot,location of system in relation `-to wells, buildings, etc. must be placed on reverse. side.) NEW INSTALLATION: (No-septic-tankwor--seepilable-within-200 feet,) PACKAGE TREATMENT { ] SEPTIC.TANK-[ S ize------------------------------------------------ S Liquid Depth --------------------------- •--s.� Capacity `-•- ------------ Type _.A ----------- Materia l_ x,G ,_a �t. No. Compartments .0. Distance''to nearest:rWell �Gtlp_�� _[�c�1Pi�'!C�__Foundation ______________________ Prop. Line-______________:___.__ 6 .. LEACHING LINE [ ] No. of Lines ____-- Length of each line---------------------------- Total Length` _;=_______-___________._.__ J ._��...k r'.ems� r 'D' Box --------i-o-T,ype Filter Material"___-"___ pepth Filter Mdteriai --------------------4---------------• ------ Distance to nearest:.'Well -------------t--------- Foundation ---------------- Property Line --------- ---------- SEEPAGE PIT Depth .... L ' ----------- Number -----------------------!.--- Rock Filled Yes ❑ No I❑ P [ ] � Diameter Water Tale Depth,------------ r ------------------------Rock-Size ---------- --------------------- Distance to nearest:e ell ---------------I-------------------------Foundation ------ --------_. --- Prop. Line -------------------- '1 REPAIR/ADDITION(Prev. Sanitation Permit r# -------------------------- - - ---------___.___.... Date--Date ------------_-----I-------------- - Septic Tank (Specify Requir'ejments Disposal Field (Specify Requirements) 0-� ----W--�- - - --- -------- `-- K �� ,Z��'�' t ------ ------------------------> --------------------------------- -- 1----------------- -------------------------- - ------ -- - (Draw existing and required additionVon reverse side) ------------------- --- -------------------------- I hereby certify that Ihave prepared this application and that the work will be clone l in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the Son'Joaquin L'ocal'Health District. Home owner or licen- sed agents signature certifies the following: ; "I certify that in the performanc 'rthe work for which this permit is issued, I shall not employ any person in such manner as to become subject to.AWllorkmain's Compensation laws of California." i :�.. Signed -I i-------- , I r ------ ---- ----------- -- --------------------- Owner BY ------- ----- -- ---- - ---- - - ---- (if of r t� wner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED E - - - - - --=------------------------------l------ DATE BUILDING PERMIT ISSUED -------------------- ----- - _ "E -' ----DATE ---------------------- ---------------•--- ------ ---- ADDITIONAL COMMENTS ------------�fa l t l ,� ---------- --- ----------------------------------------------------------------------------------------------------------------------- ------------------- _-- ----------------------------_- - --- -- - Final Inspection by: '- - ---- r = -------- --------------------------------------------------Date= ZQ ------ %SAN�J�CiAdUIIv-I:OCAI.IHEALTH DISTRICT E. H. 9 1-'6B Rev. 5M