76-1025 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 71 _........ ........................................... ----•----.... (Complete in Triplicate) Permit No. ........ ...............................I........ / 1 �-�7 .............................. This Permit Expires I Year From Date Issued 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 compliance with County Ordinance No. 549 and existing Rules and Regulations: rr JOB ADDRESS/LOCATION ..... ,... --, ......--.. ,. _..CENSUS TRACT ...........2.............. ..._ . Owner's Name ...... ......... ......:.............................Phone . ?__. �..............--- . Address , ) ,..... ........ ............. City"--...................................................................... .° Contractor Name .. -:..4 T- -----_----.:.....License # ..--- . . .. Phone .:...................:...... Installation will serve: ResidenceApartment House❑ Commercial []Trailer Court 0Mate F Other ....... :. .............. ------ _ '14 g Garbage Grinder ..;.,...,. ,. Lot Size .......................:...:... Number of living units:..... ..-'.. Number of .bedrooms ...__ Water Supply: Public System and name`.................. ........... .----------....:......................--...........................Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay C❑ Peat❑ Sandy Loam ❑ 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.) NEW INSTAL ATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ j SEPTIC TANK.1 1 Size--------------•---------------.._.................. Liquid Depth .......................... Capacity Type ................ ... Moteriol........ .... No. Compartments ..................... Distance to nearest: Well . ... ...... .. ..................Foundation - Prop, tine ....._ ............ LEACHING LINENo. of Lines . :.-. Total Length .....'sib....� � � -• - - Length of each line .. ....'�"`. ..... g '� -------- 'D' Box :..... Type Filter Material ....................Depth Filter Material .......................... Distance to nearest: Well ..........?.P------ Foundation -....� :. .- Properi Line ............ p ty -...... SF.EPA15==T ) Depth ,� X/0.. JfJ)iometer ................ Number . :.._ ... .,.......----- Rock Filled Yes No ❑ d ., •� %i Water Table Depth ......... Rock Sixes ......-. Distance to nearest: Well --------------------------------Foundation ........� Prop. Line....................... REPAIR/ADDITION(Prev. Sanitation Permit# ---..:.. .... . ...... .............-------- Date -----------------------------------I Septic Tank (Specify Requirements) ................---....... .................. ..............................•-.....----- ............. Disposal Field (Specify' Requirements) --------------- - -------- •--- ........... ---------------------- ...... -....... ---- --..... •....... ............. ............. --- --- . -- - ------ (Draw existing and required addition on reverse side) 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 Son Joaquin Local Health District. Home owner or licen- sed agents signature certifies the follo ing: "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 ........ot;h 7. ... . : ' -•---........ Owner B . .. .. ... .., � ... , .� -. title f r t an ov`�nle } FOR DEPARTMENT U E ONLI� s APPLICATION ACCEPTED BY , _`" .,-............._. DATE ._..��i/ .r�.�....... BUILDING PERMIT ISSUED - .. . ..... .. ......-- ---- ---..._.- _.. DATE ( ------------- ADDITIONAL COMMENTS ...... ........ ----- ...----•.--------.•:................... .... --- ............ ---- ....... ....... ... _....------. .------. - -- ..---- ......................................--------- - .. .......................... - ------------------------------- ------------------------ ...._------ ---------- .- - --. ... ....------...... ....'...........---------•---.... .... .... .... - - Final Inspection by: ..... ............. . --- -------Date ....... ------------ LOCAL HEALTH -DISTRICT e u 13 24 ,, 7/77 'A N