76-297 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE.- --..... --•---------•-----------•................ APPLICATION FOR SANITATION PERMITPermit Na. ..........,.............................................. lComplete In Triplicate) - This Permit Expires 1 Year from Date Issued Date Issued ._7_..._a.......... 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 itkt County Ordinance No"nd ng Rules and Regulations: �. ` ?.�.. JOB ADDRlWSS/LOC ION ........ .......... . __��.'n/....... NSUS TRACT Owner's Name - • - --- -----•--- ........... --• --- ............................. . ......................Phone ....................•............. ,. Address ........ ------ .. . . . ..........C " Contractor's Name "`-.. icense ._.. .3-�/'��?- Phone .. .. _- ---------- r 4 1 Installation will serve: Residence WApartment House J3 Commercial QTrailer Court Q r Motel Q Other----•-•---.•.._. ...--- ....:....... Number of living units:-.,/-... . - Number of bedrooms 1-1-Garbage Grinder ............ Lot Site .A;!;K............ ....................... Water Supply: Public System and name ----------------------------................................................................................Private Char6cter of soil to a depth of 3 feet: Sand Q Slit Q Clay ❑ Peat Q Sandy Loam Q Clay Loam Hardpan&D-- Adobe JQ_ Fill Material ..._........ If yes,type............... ............ (Piot 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 244 feet,} PACKAGE TREATMENT [ ] SEPTIC TANK ..4?.. Size.... .' '..................... Liquid Depth Capacity _T&+ !._...... Type`-• Moterlal-4� f!&..._ No. Compartments . Z.............. Distance to nearest: Well _!o;.;Epc�................Foundation Zvr ...__ Prop. Line ....�'`��.. . LEACHING LINE $o� No. of Lines ..,Length of each.Iin � e..__.. &.f__ Total Length [ ._.1 4�.�..-.......x P 'D' Box .._ ----- Type Filtetr Materia .. .: .. .. ..... Depth Filter Material _J.8.................... Distance to nearest: Well _. ...._ =`--__E' Foundation ......��_.-_....._. Property Line ........................ SEEPAGE PIT Depth _.___ Diameter] _C3.. Number __._.. Roe "`F'lled' Yes X No Q Water Table Depth ,- 1 ` .........I.......Rock Size /./ r. ... ....n� 'v i + Distance to nearest: Well........X�..................�..Foundati n - ....... Prop. Line ..... ............... ,.._ REPAIR/ADDITION(Prev. Sanitation Permit _..........__......................1....__ Date` .-- •--- .__.._..-•-_--_.} t - _. —. Septic Tank (Specify Requirements).. --------------•••-- I ........ . .. ,_. Disposal Field (Specify Requiremeon,t' ........ - ...... ---------------------------------•-----------------------------------------------------•------------------------- --- --•••----••------------------•----------- ......---. ............. -_---�------ ------- -----------------------------...-----------------.----- __... ....i:t......... .................................._�.................. 4' `11(1)6w 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 Joaqulte County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health".fllstrict. Ham* owner or licen- sed agents signature certifies the following: "I certify That in the erformance of the work for which this permit is Issued, I shall not employ any person in such manner as to 6ec e s b4ie to orkman's Compen tion laws f California." Signed --•-- --- , --- Qwrrer,`r 09 BY ------ -------- ....... . Title - ------ �-•.... ................................ (if other than owner) ' a FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY . --- lf' �.a.� •------_----- ------------ ......... DATE .� _.3l.-K....................... BUILDING PERMIT ISSUED ---------- - ------ ------- DATE .------------------------------------------ ADDITIONALCOMMENTS --------------------- -- -- 0 ------ ----------....----------------------------------- ....... -I------------•-•--- -----------•-•--•---•------------- ------ -----.------- ---------•---•--------•-------- ........................................... -•-----------.----•-----••............:.......... :.... Final Inspection b / . /, , t F , . s y.. ...__�. ...............••-..._..... _- ..Date .r/3/- . P Y _- ------------------------------------------- --•-•---------------•---- EH 13 24 1-68 Rev. 5M SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3M