76-862 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE- APPLICATION FOR SANITATION PERMIT Permit No. --• ............................................. (Coniplefe In Triplicate) ' 'i. :.... j..``....................: .................. Date lssuec ..................................•_. This Permittxpires 1 Year From Dot*Issued /U��1. 7 Application is hereby made to the Son'J Local Health District for a permit to constrcict and install the work herein described. this application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: ..:__ � :CENSUS TRACT ••---•--••---•----....._.. .JOB ADDRESS/LOCATION � /,� ..........................•--........._. ------ t Owner's .Na f ...., ...:................Phone -----......_.. . ......-. 2---- -�� ,pp nn ._.. ....__ --•--•'City .... .. .° Address ..�1�•J..__V�5'�s��- ..........................•-••---.._.,....-----... ... _ .. _ - ..--- ._...--------- ' .... Phone ------ 'k -- Cantractor's Name ... • •...............A.....__.Unense ._......•-•..r Installation will serve: Residence 0Apartment House Commercial E3Traller Court 0 X Z61 41 Motel 0 Other ............. . 1.........-.................. ..............•------- Number of living Units-_ ... Number of bedrooms ......_.Garbage Grinder Lot Size.--_.-. .... Private 'I Water Supply:-Public System and name -•--:..........--•--------------_.-w---_.... •- �.....__-...__..:........__..:.__...........__..._. [c}� ❑ y {] Cla Loam Character of soil-to a depth of 3 feet: 'Sand E( Siit❑ Clay o Pea! Sand Loam' y ❑ Hardpan 0 Adobe 0 Fill Materlal ............If yes,type..............I ...... (Plot plan, showing size-oil 'lot, location of system In relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATIQN. (No septic tank or seepage pit permitted if public sewefis avail b1e within 200 feet,l Y �p Si uqu Depth } PACKAGE.TREATMENT ( );'�SEPTIC TANK } . } •- id D j �= r_ a ............ Capacity .1z��'r� TypeIl�terit�l: �No. Compartments � . i O _ ........ Distance to nearest: Well ...... =- •.Foundation ...�-�1 __...._.._Prop. Line . '" ... Total Len th . .. . - Len th-of sack line.---- d•--...... 9 :, LEACHING LINE [ } No. of Lines._._-_..=•--• -=----=-k g� ... r Maters -- ._..... 'D' Box ,� Type Filter Materi ---..: p Filter al ..- �C .....-- De--t Z w, 6 .... Jf Property Line ._...�................ I Distance to nearest: Well ..._.�....... ---•-•_ Foundation ----•••••-•- .,...�_ T .......� " Rock Filled Yes o • :'".`.,"._, •-••---- •Dia meter •---- Number N SEEPAGE PIT € l Depth .----------- ----•------ �� y � .. ._•-•-•• .. .._..._... Water Table Depth --- ..._Rock Size'--.....---•-----...... Distance to nearest: Well ..._._Foundotlon .. Prop. Line .__••-- 1 -- Date ...._...' - 1 R#:PAiR/ADDITIONIPrev. Sanitation Permits "� ""• Septic Tank (Specify Requirements) . •---- •-- •..............•........:.. ...................-.................... . ..._....... i ................ Disposal Field (Specify Requirementsl = .... --------------------- ----•-.......-•--.............. ...---'............................. -- -- •---... .... .......•.. (Draw existing and required addition on reverse sidel 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 Heahh:Dilstrict. Home owner er Ifcatt- sea agents signature certifies the fallowing: rertiFy that in the performance of the work for which this permit is Issued, 1 shalt not employ any person in such manner ' as to hecome subject Workman's Compensation laws of California. r - � Owner -- Title (if other-than,owner) R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY,_._ t --- -- DATE._. .'_., __ 7 ...I... ApLDING PERMIT ISSUED ...... ------------------------------------•----....._--- DATE ......:............:.. DITIONALCOMMENTS _..-.-----•-------------------------------------------- ....-----•... •---._..._._.........._...._...._.. •--------'------- f r_- :....._.._. --....__:-----------------...........•..................... --------------------�-------- ---------------- D--- ...-'........... ...................• ---•-- --...._..... ---------' ' Final inspection by: ate ... .,� �. tip" ----•- 4 )EH 13 2} i-68, i-ev. 5M SAN- JO QUIN• LOCAL .HEALTH DISTRICT 8/74 3H ,�l 1