76-965 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION -f-OR SANITATION PERMIT ,f .................................................... Permit No. :�_......_.....---. (Complete In Triplicate) Fro '; bate Issued . ................ This Permit Expires 1 Year From Date Issued Application is hereby made to the SoIn Joaquin Local Health District forla permit to construct and install the work herein described. This application is mode in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION .. .-r •.•/.- ............... : ........Ci NSUS TRACT Name ""' , rli ..: Phone Owner's •......................... ............... :.�.. AddressL'' ;a �......._.... .._ .............. city ...._._.. _....................................... J1.:License #} ��1_. .. Phone ��l �T:• f� Contractor's Name ....... �---- •-- > jp .." Installation will serve: Residence ❑ Apartment House❑ Commercial❑Trailer•4eart- Q,� - . . Motel ❑Other --- ---------- _ Number of living units:_._.___. Number of bedrooms ..__ ...Garbage ;Grinder ........__.. Lot Size .. a.f:. -- -�r�-• •. •• . Water Supply: Public System and name . �¢ Private ❑ Character of soil to a depth of 3 feet:- ' Sand]] Silt❑ Clay (2. Peat❑ Sandy Loam ❑ Cloy Loam Hardpan ❑ Adobe ❑ FiEI Mateial ............. if yes,type ..:..............:.......... {Piot plan, showing size of lot, location of system In relation to wells, buildings,.etG..must .be placed on reverse side.} . NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) P i PACKAGE TREATMENT [ ] SEPTIC TANKf ] Size.... : :. ..., .-.l_ ..:-! :` liquid Depth .. .................. V' Capacity ._I.�-f -�ype -...I-t ... --- Material--- 2-z _._. No'." Comport -_-1 ' �' .....jJ .. ,..�.. r. Prop. L """ . Total length LEACHING LINE No. of Lines , •----- length f each l`ine...-------••--------_"--- ------- ............... 'D' Box .....`--:--- Type Filter Material .....:........ E'... Depth Filter Material `..._-- ................•--•-n 'Y- -.,�. I� N . . Distance to nearest: Well . Foundation ....---.•---•.--. Property Line .....................5. SEEPAGE PIT Depth ... .Diameter ................ Number ...................._....... Rock Filled ..,Yes. [3.......19. 0..0 1 �I Rock Size Water Table Depth Distance to nearest: Well ....Foundation .................... Prop. Line -------- ............ ) REPAIR ADDITION Prev. Sanitation Permit�# ...... .... ._........ . '.. Date ..................................} Septic Tank (Specify Requirements) ............... .. -4c�.- .... a``l r� .. Disposal Field (Spec; Requirements) _. .....' 'C '� Dis � ---- . .. .... p (Specify ............ ......-................-.............................................. ------------•. ----------....... . {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 Laws, and kules and Regulations of the San Joaquin Local Health District. Home owner or lieeri- I 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 ...._ .. •••• -•---.. .................. Owner --- --- _--------- -----.... BY ._......._ _. r. _ .............. Title ......._.__...._.........:......._...._...........__..:... (I oU_ ran owner) OR PA MENT USE PINLY f J APPLICATION ACCEPTED BY .......... .. ............ DAT . .. .BUILDING PERMIT ISSUED DA �k...: AL COMMENTS i ADDITION . . :.4 �..... ....- -••....:........•-•-••--._..:.....---................--... ....................................:............: -•--- •---- --••--. .•-- ..... .......................................... ....... _----..- .............*.... ...7-----------.........•-•-.---------.....----_-_-.-. ............_..._............ .................................. .. '...".-ti•... .#. .....................• .�................................. .�... ...r.._•__ Final Inspection b ar • --- ----------- ------•.. .......................... a e . .. ... SAN JOAQUIN -LOCAL HEALTH DISTRICT r- u 13 24 1--AR a.., s►u 7I 72 3 X