76-939 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT t ............................................. ......... Permit No. (Complete In Triplicate) .7............ . . ... This Permit Expires Date lssued // E-A res I Year from Dato 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 o. 549 and existing Rules and Regulations- JOB ADDRESS/LOCATION .. ' [ j r 1�.�.�D ..T- ►.. [) Q -. .. ^aP..4...... CENSUS TRACT r ..... ...._ Owner's Name -•---•_...©QTS..4a .... 11�.. .�k= _C ..S._ ,p Phone -----•-•-----.....� Address .. r..b_Q..Q....°l._ti ' ..- `c-- .........City� ... Contractor's Name .__..._4 �� 21 - ti` n-`�1's,..r� -...... license .!�r .5�3- Phone - qlc1 -D 7------- instollation will serve: Residence 14 Apartment House❑ Commercial ElTrailer Court E 1 Motel 0 Other.................................... Number of living units:---!-------- Number of bedrooms .. .._.__ -3 Garbage Grinder ......--..-- Lot Size Wig.!--E ................... Water Supply: Public System and name _--� Clay ......................_.............................. ivate Character of soil to a depth of 3 feet: Sand❑ Silt[] y ❑'x Peat 0 Sandy Loam.❑ Clay Loam ❑ 0 Hardpan p ❑ Adobe Q 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.) O NEW INSTALLATION: {No septic tank or seepage pit permitted-if public sewer is available within 200 feet,} PACKAGE TREATMENT [ ] SEPTIC TANK a Sim VI.- �_'....:...... s(' • •-•- -•-- --:.............. Liquid Depth Capacity 12,(7 O . ................ P ry Type _ .. Materlai c R_ No. Compartments =........... Distance to nearest: Well -----` � ......................Foundation --_l D-.... ... Pro Line `� p. --•......--- -- LEACHING LINE No. of Lines ------- g 7� .._... Total Length /-Z 0 ' s ----------- Length o each fine----- �...-•- -• ....:........... 'D' Box _.__.._._... Type filter Material ... Depth .Filter Material ....l.' ......... Distance to nearest: Well - .............. Foundation .------I......... Property Line .ZQjQ."......... 01 - .�.. Depth - �SEEPAGE PIT - --- Diameter - --- Number __: .. .`- -----•-•--.. Rock` Filled Yes No 0 �\ Water Table Depth _.-�_�Q. -- Rock Size ...�.� �-3,1 .".. -------------- Distance to nearest: Well © ...Foundation ._. '�._. Prop. Line f ...................... REPAIR/ADDITIONIPrev. Sanitation Permit# ------------------ _- Date Septic Tank (Specify Requirements) ........................................ Disposal Field (Specify Requirements) .............. ---------------- -----------------------------------------------------------........................-•--................................................................ {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 Son Joaquin Local Health:District. Horn• 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 be a7-ARA- .............. a sublet Workman's Compensation aws of California." Signed --- r --- BY •- - IN (if other than owner) R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _._-_.._ --_, -- ----------•------------------------------•-------- DATE 1!_x.3.`_. ._:..------_. BUILDING PERMIT ISSUED ..___.-- DATE ...... ...................."-----•--•..._.. ADDITIONAL COMMENTS _____________________ --------------•----- -•----••------- -•-•--------•- --------------- .........................")--------------------._... -------- -----------------------------------------------.............._-,.-..=----........-.:,._..---..._..-:.... _s.._......_.. ------ ----- •..............� Final Inspection b . •-------- •---------- ---" __ . ------------ •----- --- . _ PY ----•----•-•----._..•................. Date .��- �' ... EH 13 2 1-6 Rev. SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M X