74-56 - Laserfiche WebLink

Home Browse Search

FOIL OFFICE USE: APPLICATION FOR SANITATION PERMIT q Permit No. .._-.7 .••S• +h. ........... ................................. {Complete in Triplicate) ........................................ Date Issued ..a�.. 7 .. ..... .... This Permit Expires I Year From 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 complian a wit. Co t Ordinance o. 544 d existing Rules and Regulations: �.J .,�/....�1 .:. NSU5 TRACT .•.:..........::.:........ JOB ADDRESS/LOCATIONf •-.._....._ ...- ................................. . Owner's Na . Phone . 'it Address - -•�-t .............................. .. .. _.. .. _ .... License # •/.� . Y Phone Contractor's Nari�e ... . - _ r -,---- - installation will serve: T Residence &A7partment House❑ Commercial❑Trailer Court Q Motel ❑Other •--••-•-- ....... Y g Garbe a Grinder . Lot Size .... Number of living units:.-- --_.... Number of bedrooms .. _...._ ,, . - • Private ❑ Water Supply: Public System and,name -------------- -- ----------..-----------------------------•---•- Character of soil to a depth of 3 feet: . Sand ❑ Silt❑ Clay ❑ . Peat❑ Sandy Loam ❑ Clay Loam D Hardpan ❑ Adobe.21""Fill Material ------------ If yes,type ----------------•----------- {Plot. plan, showing size of lot, location of. system.. buildings, etc. must be placed on reverse side.)in relation-to- wells, � NEW INSTALLATION: (No septic tank-or seepci4e pit permitted if public sewer is available within 200 feet,) --•-I• .. Liquid Depthth .......................... PACKAGE TREATMENT SEPTIC TANK t Size......•---------•- Capacity Material.................. _ No. Compartments .....-.. ............. Distance to nearest:;_Well _.......Foundation ... Prop. Line ...................... LEACHING LINE [ j No. of'.L-ines F._.._-_-•-•-•-----..... Length of each line-----------•------:..... Total Length --•-------••---•---•--•--- 'D' Box ............ Type Filter Material - T---' DEpth Filter Material ....................................... . Distance to nearest: Well .....:...............:.. Foundation ........................ Property Line ..... .................. SEEPAGE PIT [ ) Depth .................... Diameter --- Number -----------..---------.----- Rock Filled Yes ❑ No Q Water Table Depth .........Rock Size ...-----••--------•----•-------- ...Foundation ._..... Prop. Line ...................... Distance to nearest: Well REPAIR/ADDITION Prey. Sanitation'Permit 56s Date ................................ Septic Tank (Specify Requirements) ---_--------- ----•• --------- � C • - -•-_ ......... ......... _._.. -. - �X •-- -- --------- - --- Disposal Field {Specify Requirements} �-•• �^� a C ------------ -------••----------------- .....�1_4�P..._ - - ----------------------------------------------•-•-----------•-----------••-----------........---•-•....... -•• --•--•--•---•--------- ----------- t ------ -- (Draw 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 Local Health District. Home owner of licen- sed agents signature certifies the following: "I certify that in the performance of the work manner for which this permit is issued, I shall not employ any person in such as to become subject to Workman's Compensation laws of California." 5i ned - --- ---•---•---- Owner 9 ---------- By Title ? }.l c�. .._!hR............. Ld ....................... lif other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -._....._-:-�•-•-------. .............' ••--_. DATE ..-®-. ±P ......._- BUILDING PERMIT ISSUED ..............:...•--•--....•----- DATE .. ADDITIONALCOMMENTS .............................................................•-----....------. . :..... �� ............� _Date......... ...4 ............. Final . ------- - ---- Final Inspection by: � • •••••• SAN JOAQUIN LOCAL HEALTH DISTRICT . NQ9 13 24 ,_'AD De.. SAA 7/723M