76-431 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE- APPLICATION FOR SANITATION PERMIT U / .... _.f?...........: Permit No. .. �— _ .. 1Complete in Triplicatel . . This Permit Expires I Year From Date Issued Date Issued _/-_'7 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 firn compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ..--.'-7`r -'T`-.�.,. .UAGF.f2.t3./ i ...Rd.:.................................CENSUS TRACT ........ Owner's Name ......... ........................r.......................... ......__..:Phone 9�.3L. .a93�,S . L � i Address .................................. ..!�rT.7.C••�._....------._.,.......--•--.............._....... City'..'.Bch.�r't?.!�(................--•--•--.......-Q•------------- 1 Contractor's Name _9-H 77.6 -----._.Ucense # .............. Phone Installation will serve: Residence bd Apartment House Commercial❑Troller Court ❑ Motel ❑Other-- -- ------------ Number of living units:---_...... Number,,of bedrooms ...Garb a Grinder Lot Size Water Supply. Public System and name ------------------------------------------------------------------..........................................Private Character of soil to a depth of 3 feet: Sand tJ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam Hardpan 0 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. NEW INSTALLATION: (No septic tank or seepage,pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK f ] Size..................... . Liquid Depth i Capacity -------------------- Type ............. ------ Material---------------------• No. Compartments ...................... Distance to nearest: Well ... ...............................Foundation .,.............. ..... Prop. Line ...................... LEACHING LINE No. of Lines .... Length of each line-------..........•-•......... Total Length 'D' Box Type Filter Material ....Depth Filter Material Distance to nearest: Well ........................ Foundation ........................ Property Line ........................ SEEPAGE PIT ( } Depth -------------------- Diameter ................ Number ..... ................ Rock Filled Yes ❑ No 0 } Water Table Depth ............. -=--.............................Rock Size -----------•-----...••--- ...... ; Distance to nearest: Well .........................................Foundation -_................. Prop. Line ...................... REPAIR/ADDITION(Prey. Sanitation Permit# ..............................---.........__ Date .................................. Septic Tank {Specify Requirements( bs;�l.� ..........................................-------•------------••---...... ----------------------- r Disposal Field (r pecify quireme)s} C� ��.,- t ...__ ------ ----------------- _4 .. . .' -- ----------- -----••--- (Draw existing and.required addition on reverse side) r I hereby certify that I have prepared this application,and that,the `work will he done in accordance .with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health:District. Home owner or licen- sed agents signature certifies the following: "I certify that in the pe rmance of the work for which this permit is Issued, I shall not employ any person in such manner as to beco a sub ct to rkman's Compensati laws o C ifornia." ff Signed �. � .. BY --------------------------------------------------- .......... -N.._.. Title -- } . (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---- - --------------•------. ----•------------- ._.:..--•---. ..DATE :.....5:._. -.._ PERMIT ISSUED ................ --------------------- BUILDING •---.-••••---------••--••----•-•-------._.._.._....----------....DATE .............................. •-----..---- ADDITIONALCOMMENTS ----------------------------------- ........................................................... .............. ------------•-------_---- -- --•----- --- --•------- •------------------------------------------------------...- ------------------------------------------ Final ----- - -------•--------•--- Finai Ins ection b Date ..- .../� P Y: .. . _- . --------- --•-----•-•----•--•--------------••-....._...•---.....---.....-•--••. EH 13 2h 1-68 mow• SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M