71-925 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -- -' Permit No. 7�"--1--�--� ------------------------------------------------- (Complete in Triplicate) -------- Date Issued --�-Q- ` ---�•l This Permit Ex ares 1 Year From Date Issued ------------------- ------------------------------------- Application ____ _.__,y__._. a Ordinance No. it t and existing Rules and Application is hereby made to the San Joaquin Local Health Distract fora permit to construct and install the Regulations:rein i described. This application is made in compliance with County i0�3� E -------------- CENSUS TRACT k JOB ADDRESS/LOCATION _____ ___________ Owner's Name ---- ------------- ;7W -------------------------------Phon ------------ - City ------ --------------------- Address ---------------------- Contractor's Name ------------------- - - --- �B~!'�----- -----License # I�� S� ------- Phone - 9-4--- Installation fr� Installation will serve: Residence K Apartment House-F-1 Commercial ❑Trailer Court C] Motel ❑Other -------------------------------------------- Number of living units:----/------ Number of bedrooms ________Garbage Grinder ------------ Lot Size A ✓- - ---------------- ------•- Privatex—_-- -Water Supply: Public System and..name-------------------------- ------•-------°- -------- ----- --- Character of soil to a depth of 3 feet: Sand'❑ Silt j'] Clay ❑ Peat❑ Sandy Loam •❑ Clay Loam ❑ Hardpan` Adobe Fill Material _ yif yes,type - (Plot plan, showing size of lot, location of systemin relation to wells, buildings, etc. must be placed on reverse side.) sewer is available within 200 feet,] NEW INSTALLATION: (No septic tank or seepage pit permitted if public Li u�d De th 'r �� G No. Compart PACKAGE TREATMENT [ ] Size.____ -� -- SEPTIC TANK - �� 1 G ® g • 7�7�_- yP _� �-------- Material-� ! - -- P encs Capac�tYl-. T�.e ! / . ---------------Foundation __/. - -------------- Pro Line __.�`�- . f Distance to nearest: �Wel1 _.__ ------------------- � i -------- Length of each ine-----/00-------- Total Length ------ LEACHING LINE No. of Lines _ - ,it ------•- _ _pe th�Filter Material ��-----------� -Ai ti. • \'D' Box .___v-- Type Filter Material __� P {� , • 5 Distance to nearest:'9Well ''?aQ-- t--------- Foundation Rock Fitlled`ne 0----------------- Property f PP. Yes No i❑ SEEPAGE PIT Depth --- Diameter _� =---- Number ---------- '-- �� Water Table Depth ---------------------------i-------- ------Rock Size ' Cft? -E— .Fdation _Id-- ------ Prop. Line ----------- .... ! Distance-to nearest: Well --------�---- Foundation -. ------------------- Date ------------------ ---------------] REPAIR/ADDITION(Prev. Sanitation Permit�# --------------------------------------------- ------------------------------------ - ------------ Septic Tank (Specify, -:- , Requirements ------- -------- --------------------------------------- ------------------------- --------------------------------------------------------------- ----------- ------------------------------------------------ "--- Disposal ,Field, (specify(Requirements] ------------__ - - - i _______________---___________ __________ • e u - - - - ----- - - - - - [Draw existing and reqaired addition on reverssee sideI- with San Jooaquin I hereby certify that I have prepared this application and that the work will done in accordanc County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner as to become subject to Workman's Compensation I'vWo'f Califorpia:" _ - - - -� Signed ---- - - r ----------- --- ------ - ---------------------------- ----------------- --------------- ------ Title ' + By ------- --- -- - -------- - --- --- -------------- (lf o than owner) FOR DEPARTMENT USE ONLY ! 7 ---------------- DATE _ �_ "-----�-- APPLICATION ACCEPTED BY �'� DATE ------------------------------ ------------ BUILDING PERMIT ISSUED ----------------------- -------- ------------ ----------------------- _ ADDITIONALCOMMENTS -------------------------------------------------------------- -- ----- - ------ ---------------------------- - - ------ --- k ---------------------------- ----•------------------------ ___D �' ci''Zf._ --�_ .-.-------- --------- - -- ----------- ---------- ---------------------------- -------------------------- - --- + Final Inspection by: .- - ---.- --------- --- -- SAN JOAQUIN LOCAL HEALTH DISTRICT G c u a 1-'AA Rav 5M -- -