76-35 - Laserfiche WebLink

Home Browse Search

OFFICE USE: APPLICATION FOR SANITATION PERMIT 51� Permit No. �. -•---- - tcomplete in Triplicate) Date Issued /.�(- 7.7 This Permit Expires t Year From Date Issued Application is hereby made to the San cam�n LccwitheCounyt0� inarnce No�549 and it to nexiscttl g Ruleand stand Regulall the atonsfein i described. This-application is le I � _..._ ie .CE ......:........ ....... .........................CENSUS TRACT JOB ADDRESS/LOCA? .... ........ ......�._._ ,�- - /..:...................:............—.Phan e J ...�..� `" Owner's Name .................. ............ ty ......... iso Address 11I -••'-•- "-"-' d - � � . Phone .._ ... License #• .................I---.. Contractor's Name ".-..• F Installation will serve: Residence Apartment House❑ Commercial❑Trailer Court 0 Motel ❑Other �� I........... ... Lot$ixa l ...... _.Garbo e Grinder ........... Number of living units•..... Number of bedrooms ...,. g '• ....Private Water Supply: Public System and name --------------•---...._----•---....-•----..�.......................... ..................... Character of soil to a depth of 3 feet: Sand'❑ ' Silt❑ Clay ❑ Peat[3 Sandy Loam ❑ Clay loam Hardpan ❑ Adobe Fill Material ...._ ......If yes,type............... ............ (Plot plan, showing size of lot, location of system in relation to welis,,buildings, etc. must 6e placed onreverse side.) x v NEW INSTALLATION: (No septic tank or seepage pit permitted If public sewer is available within 200 feet,) r+ 6 ize {x ........-•...-•••-....... liquid Depth .................. .......5 PACKAGE TREATMENT (.]. SEPTIC TANK - - Vl Capacity cam— . Materiai�� No. Compartments -••••••••••-••-- �� - _.. ..._ . p tY = Type/ ......... Prop. Line ...... Distance.to nearest: Well .... Total Length .- .._ Length "Id e__..'1,�.'-• ....... --•...........LEACHING LINE No. of Lines - -• g'D' Box Type Filter MaterialDepth .Filter MaterialJ. _.. Pro a line ........ ...Distance to nearest: Well .._,I��.__.-..� tion ..-.-.- -,-.-••• P rtY SEEPAGE PIT Depth A�. ----.. Diameter - ..--• Number ---••--....�.... Rock Filled Yes No �] ^- " ` -- -•- ---Rock Size ---•�•--.. �,-�� Water Table Depth Prop..Foundation . Pro Line Distance to nearest: Well ---1.-.-- .................. REPAIR/ADDITION(Prey. Sanitation Permit# ..................................... .....-- ..•-•-- q Septic Tank (Specify.Requirements). ................:..�....-:=----... ---_-•-............................- Disposal Field-! ( Pacify Requirements) •- ---------------- ---- ---- -----•--•--------------------- •-•••-••--... .................. •-------------------••-------- (prow existing and required addition on reverse side) I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health:District. Hoene owner or. ileen- sed agents signature certifies the fallowing: ploy any person In such manner "I certify that in the performance of the work for which this permit is issued, I shall not em as.to become stib' ct to Wo an's Coinpensati laws f al' ornia." d` mer • - ---- �--- •-------- Signed _._.-•-------•- --•..__ � - Title _.. . -------- BY ------ (If other than owner) FOR DEPARTMENT USE ONL - DATE .._ --- ---..__ APPLICATION ACCEPTED BY _..-- .--- ---------------- - --- ---- ---- �.- BUILDING PERMIT ISSUE© ..._... ©ATE ---------------------= ................•....... ADDITIONALCOMMENTS -------•------------• ............................................... -•........---------------•--------------- •------------------•---- -------------• -------- = ----..._......-------------- ........................--,- •------ - _..._...ate ------------------- ........................ Final Inspection by: ---------------- ! " EH 13 24 1-68 Rev. 24 SAN ! AQUIN LOCAL EALTH DISTRICT 8I7� 3M