76-825 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT (Complete In Triplicate) Permit No. ..................... ..... ...... ............................................. 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 pn nstall the work herein described, This application 1s made In compliance with County Or finance No 4 and exietl ule nd Regulations, JOB ADDRESS/LOCATION .- . �.' _ ...... ...... ........... ld �1u ..... NSUS TRACT Owner's Name ............ a ......... ._Phone Address ... - .....--�--.....- . .�'�. .�.. .. �/sr �•.. ................... ...............�.... .................................... .... -- --- ......_ city . .. ..,.... . . ... +� Contractor's Name ..... •- .- -- ••--• _-- .��-_-- ----- ._.License # ....�/.�..�. Phone i � ....._.....� Installation will serveh Residence partment House Commercial❑Trailer Court C) Motel ❑Other---••----------- ------•---•----•-- Number of living unite:..-_4 Number of bedrooms ......Garbage Grinder�.�... Loot Size ...��.�.. Water Supply: Public System and name ................................. ..Private Character of soil to a depth of 3 feet. Sand SiltI' � D ❑ Cay t❑ Sandy Loam ❑. ._Clay.Loom ❑ Hardpan[] Adobe i!i Notarialf 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 INSTALLATION: iNo septic tank or seepage pit permitted if public sewer Is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK f ] Si:e............................................ liquid Depth ........................... Capacity .................... Type .................... Material...................... No. Compartments W Distance to nearest: Well ...........................Foundation ... Prop. Line r iLEACHING LINE ( ] No. of lines ........................ Length of each line............................ ......._. ....------........•...�\\ Total Length .......................... 'D' Box ............ Type Filter Material ....................Depth Filter Materia! Distance to nearest, Well ........................ Foundation ........................ Property Line ..................... SEEPAGE PIT Depth Diameter ................ Number ...... Rock Filled Yes ❑ No -19 Water Table Depth •---••.................................•......_.Rock Size ................................ Distance to nearest, Well ........................................Foundation .................... Prop. Line REPAIR/ADDITION IPrev. Sanitation Permit# ............................................ Date .................................. ) --.................. Septic Tank (Specify Requirements) .............................. _ Disposal Field (Specify Requirements) ..... -Gr .. .._ ��....... ....�.... ......... ............................................... ...................� .y .v••• ___•...._...K............................................................................. ........................................_ _ .J ...... ............__............_.-_... + ............................................................... {Draw existing and required addition on reverse side) I hereby certify that I have,prepared this application and that the worts will be done in accordance with Son 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 following: "I certify that In the performance of the worts 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." -caned ................... _ .. .... ••--...................................... Owner By ..... ........... ....... ._.........._ .Title .. ........ -----. .... ......... (If other than owner} -�"'•��••••••.••• FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ...... BUILDING PERMIT ISSUED .................... . ........................................... ....DATE=.:................... ADDITIONAL COMMENTS .... ..........---- ................................................ ............. .......................... . ............. ................... .... Final Inspec b P y. . .. .................................. ............................Date ........ / .-.......... EH 13 2h 1� I�9' SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M