74-199 - Laserfiche WebLink

Home Browse Search

+FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ...... ...... ..... ---------------- Permit)40. ..7 .....J.. (Complete in Triplicate_); This Permit Expires l Year From Daa Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein described. This application is made in compliance with Count Ordinance No. 544 and existing Rules and Regulations: JOB ADDRESS/LOCATIO -•.......................................CENSUS TRACT .......................... Owner's Name .........-- -•--•---• -----.... !l.!-1. 1urJ........ ......................................Phone . Address ..............••...... ...................... City ..........................-.................................................. Contractor's Name .... -•-•-• - .. Y,G ...............License # ,5 _'J� _ Phone Installation will serve: ResidenceoApartment House❑ Commercial ❑Trailer Court 0 Motel ❑ Other ........................... ..................................... Number of living_units:.._/.......Number_of.bedrooms,__=2—..Gorbage_Grinder ........ Lot Size ....�D...`_X1. .............. i Water Supply: Public System and name ------- _._-_--•..............---•-••---------------•---•---------AaA .... .................Private ❑ r Character of soil to a depth of Meet: Sand,0 Silt❑ Clay ❑ ' Peat❑ Sandy Loam [] Clay Loam ❑ � Hardn❑ Adobe Fill Material -----------. If yes)type -------------------------- (Plot -..------ --._..(Plot plan, showing size of lot, location of. system in relation to wells, buildings, etc. must be placed on reverse side.} is NEW INSTALLATION: INoseptic tank or seepage pit permitted if public sewer is ovaillible within 200 feet,} PACKAGE TREATMENT [ ] Sl PTIC TANK i ] Siz�____-`-:. ---__"----R__... Liquid p ...... uid De th _... Capacity .................... Type .................... Material:t:l, ......... No. Compartments Distance to nearest. Well -.Foundation Prop. Line .._ ................ ---.._.. .......... LEACHING LINE [ ] NO of Lines ----------------- g ccline-- -----_--.--..-.- ---- Total Length ........ � -_-.._. Length of each :---- � . D' Box ---------- Type Filter Material ...............�e!Depth Filter Material .......__.......... ........................ Distance to nearest:-Well-...................... Foundation : ._ .... Property Line SEEPAGE PIT [ } Depth ,.__.._ _. __.... DiameteP -.Number ___ __.-._--.1...... Rock Filled Yes ❑ Nc ❑0 Water Table Depth --------•---•---- ................:.............Rock Size, Distance to nearest: Well ...................... ......:......;::: Foundation -_ .......... Prop. Line -----------•.......... �+ REPAIR/ADDITION{Prey. Sanitation Permit# ..... ... ....:c.:-_-- Dale .•-•-•--. .. .......•---•-__-} l . Septic Tank (Specify Requirements) ...rt'--°. �?.Q--------------------- - ------- � � e Disposal Field (Specify ;Requirements} ---- ---_.. 1� ....x_ -- I -••---.... ................... 1............ ... -- ------------- -•-----•••-••.._.........-- ... ` 1= -•--•- ' ; --•-- lw _(Draw_existing and req`uireci"addition on re-reuse side)I 1 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 or licen- sed agents signature certifies the following: ` "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California. Signed -------------------I-------- --•---- ............ ------ Owner ' y— By .._......... "ot ........ �. _... Title ........_4.f-%;.:2.. __................. i on owner) MENT USE ONLY APPLICATION ACCEPTED BY ----- . -- ..... ....` -------- ------------------------------- DATE ..... �? / . 7 ....... BUILDING PERMIT ISSUED ......... ... . " " ---.................. DATE ..........•.............�-----........ ADDITIONAL COMMENTS i s � a.. .....: . . .{. .....`. ........................... --------------..-_....................... ... .... ..- ................. _ ------------ ----•- ...................................................................................................................•---•-- ...................... . ......... .. ... •- -----------------------•----------.............._.--•--------------------------------- ................ ............. Final inspection by: .:....................................................Date . ....... N JO QUIN LOCAL HEALTH DISTRICT