74-226 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICAVrON l=OR SANITATION PERMIT J;- 7 r� --------------- --------------•- Per No. --------�'--.._..__. (Complete in Triplicate) ---------------------------------------------- 3 �� v __________-_ 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 and install the work herein described. This application is made=in compliance with County Ordinance No. 549 and existing Rules and Regulations. JOB ADDRESS/LOC TION -----------------------------------------------------------------------------CENSUS TRACT --------------------------- Owner's Name ---------------------- ----•--------------------------------------------------Phone --�4�_-_ e'J Address 7 '�� -S_ ------1/oic,-thwvc-/------------------------------•--- City Contractor's Name ------------------------------------------License -6ST� _ - _. Installation will serve: Residence ❑Apartment House❑ Commercial ❑Trailer Court i❑ Motel 0 Other Number of living units_____________ Number of bedrooms ______:Garbage Grinder ------------ Lot Size -- 1 _____--_.- •.."y, Water Supply: Public System and name --------------------------------=--•----1'--------------------------------------------- Private B v Character of soil to a depth of 3 feet: Sand" Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material ------------ 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: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) ' PACKAGE TREATMENT [ ] SEPTIC TANK'{ ] Size----- ------------ Liquid Depth :________,_____� Capacity/,P-0-4f--------- Type-C'-(!<'!Material Y —5_'.n No. Compartments"-"---, ........... '- Distance to nearest: Well _______4-16-1_ Foundation Prop. Line --- ----- ------ LEACHING LINE [ ] No. of Lines ------:2-�n----------- Length of each line______ ----------- Total Length ---------------- 'D' Box ... Type Filter Material ____________________Depth Filter Material ---/9.i---_-__-____________._________.___. Distance to nearest: Well ---- ____ Foundation ------------ .Property line --------------- SEEPAGE ___--__._._ -SEEPAGE PIT [ ] Depth ____________________ Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No .i❑ 1 Water Table Depth ------------------------------------------------Rock Size -------------------------------- Distance to nearest: Well ----------------------------------------Foundation _----------------_-. Prop. Line ...................... j REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date -----------------------------..._-) SepticTank (Specify Requirements) ---- ------------------------------------------------------------------------------------------•------- ------- ---------------- tt DisposalField (Specify Requirements) ------------------------------------------------------------------------------------------------------------------------------------- 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 Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- Q 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 W rkman's Compensation laws of California." # Signed - - - ------------------------- ----------------------------- Owner n BY = ------ -) ----- ---- ------- e/----- ---•----------- ----------- Title ------ ---- (If other than owner) I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - - '----------------------------------- ---'2 b DATE BUILDING PERMIT ISSUED -------------------- -------------------DATE -------------------------- ---------------- ADDITIONAL,COMMENTS -------------------- - ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------- --- --- ------------------------------------------------------------------------------------------------------- Final Inspection by: - =-------------------------------------------------- ---------------------Date ---- - ---—:------ i SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'b8 Rev. 5M r�