74-704 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATIOat�l FOR-O SANITATION PERMIT ,� - - ._' ..- Permit No. ..7 .. -- (Complete in Triplicate}��-w.'. UQ... .?.................................. Date Issued ` This Permit Expires I Year From Date Issued Application is hereby made to the San Joaquin Locdl,Health,Distr-ict for a permit to construct and Install the work herein described. This application is made in c�{o--mpliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION . ..Q _:._. /.0. lfP.�•----•--------- • .................................CENSUS TRACT _----------- ............ I Owner's Name ._1`'_--.... � ...............•-••--------••--......................................Phone ................. ....... y � Address ��f� ._...�........ .............� t:...._... Cit _ Contractor's Name ..... eg19 A�sB/�------------` -------------- a? .r -bo*;?7_P_..._.License # /�:��P- Phone Installation will serve: ResidenceXApartment House❑ Commercial ❑Trailer Court ❑ Motel ❑Other ............ ------------------------------ 041 Number of living units:../...... Number of be/drooms`".-�-: ..Garbage Grinder //0.--- Lot Size �V xx:/ rv---•-••-•-••••. Water Supply: Public System and name _&4e/j/ ----lor/ ��rliF - r------•------------- ----------- ------- .Private ❑ Character of soil to a depth of 3 feet: Sand b Silt❑ Cloy ❑ Peat❑ Sandy Loam ❑ Clay Loam 0 Hardpan ❑ Adobe ] Fill Material ...........I 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. j Size........------------------------------------...... Liquid Depth ..-....................... Capacity... . Type .... ............. Material........ .._...:.._ No. Compartments .......................0 Distance to nearest: Well _ ._................. .....-Foundation ..................... Prop. Line __.. ........... ' LEACHING LINE [ ] No. of Lines _. Length of each line.......I.................... Total Length: ............................ Box ..... Type Filter Material _.------- Filter Material ........._...4.:..........................� Distance to nearest: Well ........................ Foundation ........--.....--------- Property Line ---...___...._........__0 x V)� SEEPAGE PIT [ ] Depth .. . .: ......... Diameter ................ Number _............................ Rock Filled Yes ❑ No (3 Water'Table Depth _.. .--_---------_ --•---------------Rock Size ............ -----------.._.._.. Distance to nearest: Well ........................................Foundation _.....- ....... Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# .-------...........-------------.`._........... Date ------------ ------------- ' Septic Tank (Specify Requirements[ .......--- -_... -•--:--;-�------- of .... Dis osdl Field (Specify Requirements) .... -----W �.. - ----- YJ _ - (Drew 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- 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 Workman's Compensation laws of California." Signed .-.- . ...... --- • -• ....... . ... Owner By .... ....... ----......-........-- ------------_ -Titie .. � '.........._........... t er than wner) { .' F RTMENT USE ONLY DATE rr .. APPLICATION ACCEPTED BY .... .-------•----.._ ._..-. ...... � .: . BUILDING PERMIT ISSUED ............. ---- ---- .. ............•-------...--- :-- ---- __.DATE ---.... ......_.. .... 11. ADDITIOcN�AL CO NTS .. ---.-- ----- - ------------- ---•............. ................................-------- 3. --------- -- 1� . -------... •.............. . ....__---- --- ..__ ---..-..----------------------... ---------------•-------•------ - .-- ate j7`-./ Final Inspection by: .. ._ . --------------� ....-----•-•--•----- .._.....------ D C -. . lrf...._._......_. AN JOAQUIN LOCAL04-1EALTH DISTRICT ------ n_ ` - ' n.., til