76-981 (2) - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: " APPLICATION FOR SANITATION PERMIT .. (Complete In Triplicate) ............. Permit No ___ This P*Rnit Expires t Year From-Date issued Date Issued �A'-.7.. , Application is hereby made to the San Joaquin Local Health District for a' perm#t to wnstruct and Install the work herein described. this,application is made in com liance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LO ION ,.. _.... .. .z4.�............................CENSUS TRACT ....•.. Owner's Name ... ._ 4 :............... F n -•�� .Phone��.�,7�j�. Address ... .-�.5.4 �..GJ �'d,�^ �' f �" �:.. ... .. . ... .. .: ._ City Contractor's Name - 4. �.._. ... -�....... ........License Phone ,.... Installation will serve: Residence) Apartment House❑ Commercial❑Trailer Court ❑ F Motel ❑Other ................ .............::........................... + Number of living units:..I._.._._ Number of bedroom Garbage Garbage Grinder ............. Lot Size ... 1 `3� . ........................... Water Supply: Public System and name ...... .................. ..................................................Private Character of soli to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam 0 Clay Loam Hardpan Q . Adabe� Fill Material ...----•.... if yes,type (Plot plain, showing size of''ldt, loccition 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 200 feet,) [ PACKAGE TREATMENT SEPTIC TANK IVs, f .�. _.. . ize ? ...� Liquid Depth .... . ................ ............... . r ' Capacity _C�ra_.... Type Material - .. No. Compartments ... p Distance!to',nearest: Well __ -..6)_ .., Foundation Prop. Line . LEACHING LINE � No. of Lines . ��.............. Length of each -#ne-°. .�__. Total Len th I.7.0 r ........ 'D' Box .'. : .. Type filter Material ;.Depth .Filter Materiai�. ...r.�.'I....---- ..........` ---- Distance to nearest: Weil' -Q- -----•--._.. foundation =�..d:�::..._.::.,.a Property Line .. ® r SEEPAGE PIT 0 Depth .�...... Diameter-�1�.-Z Number . flr �::.... . - . ...... Rock filled Yes No i❑ Water Toble)Depth ... --••....................•..-'.....:Rock'Size yL .. f w.. Distance to nearest: Well,__!�_-.�.............. ......foundation ._._. � Line REPAIR/ADDITION IPrev. Sanitation Permit Prop. Date ' Septic Tank (Specify RequirementsJ. __ ........_ - ..................•- .,_. ........-----•--•--......... ... � t Disposal Field (Specify Requirements) .................... --__---- -----•------- # E t 1-1 -IDrow existing and required addition on reverse•sidel I hereby certify that I have prepared this application and that the:`worit will be done in accordance with fan Joaquin County Ordinances, State Laws, and Rales and Regulatlons of the San Jaoquin,Local Heahh:District. Home owner or 11CM- sed agents signature codifies the following: f1 1 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 bece e sunect t o�rkma"�'s Comp cation law of Californias." Si n ed _.._.-._.-► .�l�a r . ------• --•-- -- - Owner BY -••-----'- ---------------------•-------- Title .-. „ -. _.. (If other than owner) ----••----_.---._.._.. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _- . DATE/ -G .---•._. = ..._. BUILDING PERMIT ISSUED . • .... ......::............•-•---- ....-- ........... ....__.._.' ..r.... ...`.:. DATE ....... ADDITIONAL COMMENTS --------------------.�..........:..- _.. _- s , E ------------------------ M. : .t _ _:.r- .-.._.._. - ... -------------_..._. _ .....__---.-__-_.. —..__—` ....... ... . ............... .- ... -.._. : . ------------- ----------------- final Inspection by .: --- Date.. ate r! EH 13 2 3-6(1 lieu• 5m SAN JOAQUIN LOC L HEALTH DISTRICT 8 k /7�t 3M ,