72-462 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No: - -Z.--- -------- - --------------- --z-- ---------- ----- --------=--------------- -------------- (Complete in Triplicate) Date Issued -S- -------- { This Permit Expires 1 Year From Date Issued ------------------------------------ --------------- Application is hereby made to the Sa Joaquin LocaEril Health District non a for a Nom549 and existing Rulesinstall, the herein described. This application is made in compliance Y rA711,e-6P �J / /� ---� -- tt JOB ADDRESS/LOCATION ._-_ /C.y+ V�--� CENSUS TRACT ----------------- --- ---• ----- - ---------Phone --- �-�'--�- Owner's Name -----��5-�l1_S-.��-�Il.------ -----=---'-:------- - - r Address �?�l .2 city ---- ------AA-7- 1 ---- - - Contractors Name ------4� ----.License #C� :.- . Phone c;23-J � { Installation will serve: Residence �partment N,ouse,❑ Commercial ❑Trailer Court l❑ Mote! ❑Other ----_ - ! __-Garbo a Grinder _ Lot Size - f`r ----------- ---- Number of living units:_-.__ -___ Nu,ber of bedrooms -. --- 9� 19,15-------------------------------------Private ❑ Water Supply: Public System and name _---� =��--•�-��-f---� ---- Character of soil to a depth of 3 feet: Sand'❑ Silt ElClay ElPeat E] Sandy Loam Clay Loam 'E] Hardpan ❑ Adobe F1 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 [ I SEPTIC TANK f ] Size------------------------------------- ---------- Liquid Depth -------------------------- No. Compartments ---------------------- Capacity t Type -------------------- Material--------------------- Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line ---.----------------.. - --- Total Length ------•------ A' LEACHING LINE [ ] No. of Lines _ Length of each line------ ------------------------ ---- -- g -Depth Filter Material ---_-_----- -• x 'D' Box ___-- --_-- Type Filter Material ------------------- Property a Line ------------------------ Distance to nearest: Well ------------------ ----- Foundation ------------- - P rtY Depth - Diameter ---------------- Number ------------------------- Rock Filled Yes ❑ No [j- SEEPAGE ❑ SEEPAGE PIT [ ] P ------- -------- Water Table Depth ---------Rock Size --- ------------------- ----- ---------------- R ----•-Foundation ------ Prop. Line --------- ---------- Distance to nearest: Well --------------------------------- • REPAIR/ADDITION(Prev. Sanitation Permifi# -------,----`------------------------ ------- Date -------------------------------- ---------- ) Septic Tank (Specify,Requirements) ---------------------- Disposal Field (Specify Requirements) --------- --------- G ------------------=--------- --------------------- ------------------------------------------------- i -- - ----------------------------------------------------------------------------------------------- (Draw existing and required addition on reverse side) hat the work will be ne in accordace I hereby certify that 1 have h San Joaquin pared application Rulesand Regulations tof the San Joaquin Local oHealth D tri t.Home'towner or 1 cen County Ordinances, Statee , 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 kman's ompensation laws of California." --------- --------------- Owner Signed - ��. �---- -- - _� - - Title - -------------------- - ----------------- BY ------------------------------------------ ---------- - - ------------------------- - (If other than owner) FOR DEPARTMENT USE ONLY -- -------------------------------------- - DATE - _ grf ,------- APPLICATION ACCEPTED BY ---- - -_-- - - BUILDING PERMIT ISSUED -------------------------------------------------------------- --------------------------- -------- ---DATE - ---- ----------------- --------------- ADDITIONAL COMMENTS ------------- ------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------ ------------------------- ------ - 4F- ------------ -------Date -. -- --- Final inspection b - ------ ------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1-'6B Rev. 5M