78-275 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE- APPLICATION I FOR SANITATION PERMIT Permit No. -------- .......... ............. (Complete in Triplicate) I - M. I.:,- . - I ..". . 7.1 ........................... .................. . Date Issued j� --------------------- This Permit Expires I Year Frown Onto Issued - - ................................. Application is hereby made to the Son Joaquin Local Health District for a 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 .................. ....... ....CENSUS TRACT :.--••------..._......._._ P - —1 ....... ................I——.......phone ...AR 6-9f... Owner's Name ------- ....... br.rr. ....... ... .......... ------------------------ . Address .............. .. ...... .. ....... ......... city Contractor's Nome .......... ........ ......_.License 337'1--- Phone Installation will serve: ResidenceR Apartment House 0 Commercial oTraller Court 0 73 Motel []Other................. ...................... Number of living units:-.I----.- Number of bedrooms ....Garbage Grinder 2W).... Lot Size Water Supply: Public System and name ...... ........................................I................. ..................................... Private Character of soil to a depth of 3 feet: Sand 0 Silt 0 Clay 0 Peat 0 Sandy Loam Clay Loam' 0- Hardpan 0 Adobe 13 Fill Waterial ............If yes,type............... ............ • Mot plan, showing size of lot, location of system In relation to wells, buildings, etc. must be placed an reverse side.) C 67 NEW INSTALLATION: jNo septic tank or seepage pit permitted If public sewer is available within 200 feet) V j 12.Q.f . c,� 44 Liquid,Depth ,s7ff---64,, . PACKAGE TREATMENT SEPTIC TANK'S I Size------- ------ )........ Capacity �Type Material Afff - .No. Compartments ........ Distance' to nearest: Well. ----- .......Foundation ./.O. Prop. Lineo..... .. ..... LEACHING LINE No. of Lines ---------------- Length 6f each line.'70. Length a-.ID-- - --------- .. .. ........... Total Leng i, V Box ...... Type Filter Material ALA.dkbepth Filter Material A .. '......_•...---.•............. Distance'to nearest: Well Foundation Property Line SEEPAGE PIT Depth ...................... Diameter ................ Number ............... ...... Rock Filled Yes No (3 Water Table Depth ------------------------------------------------Ro&Siii.............. ........... D.istance to nearest: Well .....................I.......... ........Foundation ..................... Prop. tine ...................... REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date .................. ............ SepticTank (Specify Requirements) -------- ......................e.................... ............................ ....................................... ...........---------- Disposal Field .(Specify Requirements) ----------Z............................................................. .............. ...... ................ ................. ........ -------------- --------------- --------------------------------------------------I------- --------------................................ (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 J"Muln County Ordinances, State Laws, and Rules and Regulations of the tan Joaquin Local Health,,District. Homo owner or licen- sed agents signature certifies the following: a "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 sub(qct? to Workman's 9orpensation laws of California." Signed --------f. ------............ ---------------------------------------- Owner By .. --- - ----------- title 1��..... ............ ............... (if other than owner) 66R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ...... ------------1......: ------DAT BUILDING PERMIT ISSUED -------- -- ----- --- . -------------- ------- ------------ ..............--------- ------ ...........DATE ..................................... ADDITiONALCOMMENTS .--------3-------- ------------------------------------------ ................................................... .......................................... .........................L--------------------- ------------------------------------------------------------------............ -------------- -----------------1--------------------------- ........................-----.•-------------- ------------------ .............. .. ............... ................. ...I——---------------------------------------- ---------------------- ----I----I - - 7 ' ---------------------------- •........ .. . .. ......I... ...__...-•--•-------•-•-••--------------------------------....---------- ------ t3---- Dote final Inspection by- ------ ------------ EH 13 24 1-68 Rev. 51 AN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M