74-598 - Laserfiche WebLink

Home Browse Search

FOR OFFICE IJSE: ";. APPLICATION! FOR SANJTATION PERMIT - ....... ....... ..........'_. ...... Permit No. .�.<-............ (Complete in Triplicate) ................... .................................. /�, 7 . ..........--•....................... ...........•...-... This Permit Expires 1 Year From Date Issued Date Issued ....... 10S-2.4,v_ ja Application is hereby made to the San Joaquin Local Health district for a permit to construct and install the work herein ' described. This opplication-A,Fn,ade in c mpliancwith County Ordinance No. 549 and existing Rules and Regulations: ' /'.._. JOB- ADDRESS/LOCATIO ��... :....rz CENSUS TRACT .................. , Owner's N me��/p�� S!.. t: .�" c.�14�. :.. .•--•............. ......Phone '.��.�� 1 Addres r C'sC %l /lam ......I....�.��.-� ........... f _. ....... City /. Contractor's r4ame ...................... •-•-----......----..._.License # .._ Phone .............................. Installation will serve: Residence �artment House 0 Commercial ❑Trailer Court ❑ I Motel ❑ Other ............................ --------------- Number of living units:..___.•.. Number of bedrooms _.....Garbage Grinder _..._ ...... Lot Size ------------- Water Supply: Public System and name .G.J"--e-_`2...............--......................---•-------.-...__....-......------------- --------Private 0— Character of soil to a depth of 3 feet: Sand 0 'Silt❑ Clay ❑ Peat❑ Sandy Loam Q_,Clay Loam [] {v. Hardpan ❑ 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.) Q NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet] Z, / PACKAGE TREATMENT [ ] SEPTIC TANK Size_iii "�C- ----.•-------- ------------- Liquid Depth .-.'/:...�'.__- Capacity�o�Ddr.�...... Type --------•----------._ Material-..------- ... ....... No. Compartments ...................... , r r � Distance to neare t: Well ... C----__.__._._---_-_Foundation ...y!Q............. Prop. line _&7....... LEACHING LINE [ ] No. of Lines Length of each line Total Length __ -------------- D' Box __. . . T ,t. . Depth Filter Material _._..�d..�._........ .- ype Filter Material ..- ..-_ ' ' Distance to nearest: Well __.. ------------ Foundation l-0............. Property line ._j -----•-:-•- SEEPAGE PIT [,/J Depth ..' _..... Diameter .._..�?3_r,_. Number ._...... . 0 ............ Rock Filled Yes No C] Water Table Depth .... ------- ----- ---------------------Rock Size ......._ .............. br Distance to nearest: Well ----------------------.........---------Foundation ..._....... ....... Prop. Line --_-------_..___..-... REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date ....--------_----.-_--__--.---) 1 Septic Tank (Specify Requirements) ----•--_..... ..---• -•-• • ...... -•------------•---•..................__-.:............... f Disposal Field (Specify Requirements) ------------------------------------ --------------- ......................--.....-. • .-............................-------•- J --------......... ...... .. .....................................----- ----------------------- ......... ..... .........-............ ---------- (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 taws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or Iicen. 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 subpect to Workman's Compensation laws of California." Signed _.__._ .,-. /JZ• -� G�C:�%�f. .................. Owner By .--- . .................... ....................................... Title (If other than owner) R DEPARTMENT USE ONLY r –— NG PERMIT IS ........ ...... ...... . ..... ---....---- .. ................ ..-_.r.._...BUIL .,. APPLICATION ACCEPT B DATE ..7:'-. . ...__..... 11 ADDITIONAL IONAL OMMENTS ......... ...... _...._._....----••-------------....-_-_----.- ------._.....,�_._..-..__.....----.'- DATE:._----...,_.--- �.,,�:_�::.::�.....-------• ------------------. ------------------------ ---•---- ..... ---- ---------------- ------ ------------- ----• ----------...... . ................................... ---. ........... _..... ----------------- Final Inspection b , -- .D ate . . __....__. SAN JOAQUIN LOCAL HEALTH DISTRICT .r 7/793 u =mss