76-473 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT � ••----------•----:•--............................... Permit No. - , = ._ - lComplete in.Triplicate} _. j "........................................ ti .............---........••---...__..._............ f�3 d This Permit Expires 1 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: JOB ADDRESS/LOCATION ...L.7L.Z..---•. ........ . . .... 1................................._................CENSUS TRACT .................. Owner's Name --------- - - -- ---------��. --- -... ...................................:...................,.Phone . . ---... ...... .._...... --- Address f � ------- ----- ............City ..: 1;n- ... . --..... .License ----. -- --- # _ Phone Contractor's.Name ► �� Installation will serve: Residence tdApartment House❑ Commercial❑Trailer Court 0 Motel ❑Other—........................................ . Number of living units:-_._ ___--.. Number of bedrooms ............Garbage Grinder ............ Lot Size :--..................''` - Water Supply: Public System and name ........................................................_..................................................Private ,,,,Character of soil to a depth of 3 feet: Sand❑ Silt n Gay ❑ Peat❑ Sandy Loam 0 Clay Loam� Hardpan ❑ Adobe W 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.} I NEW.INSTALLATION: (No septic tonlE or seepage pit permitted if public-sewer is available within 200 feet,) i PACKAGE TREATMENT I ] SEPTIC.TANKI�]w � Size--------------------=-----i.---.--._........__. Liquid Depth . --- R •---•- . .,capacity - �� } -------------------- Type --------- Material........ No. Compartments ...................... T Distance to nearest. Well --------------- ...... �'........Foundation ....... __ :�:?.:.. Prop. Line All .. LEACHING LINE f ] No. of Lines .........:.............. Length of each line,.___....................... Total Length {{ 'D' Box - `--,._. Type Filter Material ...:................Depth Filter Material .._.._.......___......_...._................ Distance to nearest: Well ........................ Foundation .......................: Property time .-...................... 4 SEEPAGE PIT ( l y.Depth ._...4 .____--. %- Diameter ................ Number.,.,. Rock.Filled Yes ❑ No „ * . Water Tablei Depth .- ....................................Rock Size Distance to nearest: Well __._Foundation ....._. Prop. Line REPAIR/ADDITION)Prey. Sanitation Permit# .........................................:..._ Date ...........__....._._.._.....:..:..) rSeptic Td k (Sp`ecify Requirements) ---- -.......... .................• ......_,................ Disposal Field {Specify Requirements)——......6; =- ----------o ......-•=- ` � -- ..............................---•------------ r, �(' r ' ---------------------------------------------•--•• ----------------------------------•--•--••• .......................... .......................... (Draw existing and required addition on reverse side) 1 3 I .hereby certify that ! have prepared_ this_application and that. the -work will be done its accordance with San Joaquin County-Ordinances;State Laws, 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 Ear which-this permit is issued, l shote not employ any person in such manner } as to become subject to Workman's,Compensation laws.-of California." Signed - ---- --------- ----- --------- Owner BY ----- ----------------at�her ----- -- ------ ----.....__.......------- Jibe -------- (if neri _ F R D P TME USE NL: APPLICATION ACCEPTED BY ------- --- �` --•--- DATE_----!:.7-�.J.7�------ BUILDINGPERMIT ISSUED _...-- •---------------- -------- ------•----- ,_.._........ ...... ............_...---------DATE -----•----........._......-------- I ADDITIONAL COMMENTS ---------•-----•- ...---•----- ----- ----- -----------•------------=---------- -------------- ....................... FinalInspection by: .._- -------•--•------------------- ------....._.-.._..-------•---------...Date ------------------------- EH EI 13 2b 1-58 Rev. 5m SAN .1OAQUIN LOCAL HEALTH DISTRICT 8/7h 3M