77-466 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 77_ ,/�` a (Complete in Triplicate) Per No. ...... .......... _....... --.................... ._.t . . _-- __ _ .- - .: _-:.._.._. _.._..,._..�-_.•-,n-,...�-_-,. _ _t_.____ .. 77 a .......................................................... This Permit Expires 1 Year From Date Issued Dote Issued . .::2-" 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 No'..549 and existing Rules and Regulations: F .. D SC .106 ADDRESS/LOCATION- .. ...... . .... .•.,.. .... CENSUS TRACT .......................... Owner's Name .... 1/ ..................... ....... ....)Phone .,... ..... ...... Address ..-. _ - city ...... .... Contractor's Name LicensePhone ...... Installation will serve: Residence Q Apartment House Commercial [3Traller Court ❑ -Motel ❑Other ra_.r :: _ Number-of .living units—.......... Number of bedrooms ....._......Garbage Grinder ............ Lot Size ..-. . Water Supply: Public System and name -----------------•- -..M.............................................._...........................Private Character of soil to a depth of 3 feet: _Sand❑11 It:p Clay Q Peat❑ Sandy loam U Clay Loam E3 Hardpan Adobe 0 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: INo septic tank or-'see age pit permitted if public sewer li available within 200 feet,) . PACKAGE TREATMENT € ] SEPTIC TANIGI. / Size... ....2 _l.V..Li _�............. Liquid Depth ....#................� -Capacity -�..� �?-_----- Type i.c- Material---.. .Y No. Compartments ..2. Distance.to nearest: Well ..........L_Q.b.. ..........,FcFundation ..`JV.`.......... Prop. Line ... _f............ LEACHING LINE I No. of lines .............: Length of each line--- ..W k..[4�'7.... Total Length ... 7 - .......... i Box . -.:._..: Type Filter Material ........Depth .Filter Material ......1..�/................................. Qd�� Distance to nebrest: Well _._. ..�V.� Foundation -....L .._... Property Line ........ .:... SEEPAGE PIT [ Depth --------------- i:3iameter ..`..... Number ..:.....�..._.............. Rack Filled,_-Yes [3-' No Water Table Depth 9 .. V..� Rock Size .�. X. 3.:.•-__---- Distance to nearest.• Well . ........... Foundation -_•./.. Prop. Line ... .. REPAIR/ADDITION(Prev. Sanitation Permit# ..........•............................:.... Date ........................ Septic Tank (Specify Requirements) Disposal Field (Specify Requirements) ........................................ .............................................................................<.......... f .... ................•-•---•--•-----•----------_... ..................._..._._.._._...........__.... •-•---.:.... �- - ----•------------------- .......... ...... ..... ..._.._._..•---.._•••. .............. (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 San Joaquin Local Health,District. Home owner or liven• sed agents signature certifies the Following: "I certify that in the performance of the work for which this permit Is Issued, I shall aw employ any person in such manner as to become subject to Workman's Compensation taws of California." Signed --------------------------•--------•--------- ------ Owner . BY •--- --- --- -- t------ Title _. - _:..' . .... :. Of other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ....t '--i _._ . . - DATE �.'. ------------ ---- BUILDING PERMIT ISSUED _.. ----- -� .:::.:�:..:.: DA?E ........................................ ADDITIONALCOMMENTS ..... • -• --••-..---•••--------••._...--•----•--•- --•-----------------•--•- ---•---------.._.._..-._.,-.....---_.........------- --------------------------------------•_-•- ............................. --- - ................--- -•......................................:............................ Final Inspection bY: ... = Date K J/_ ..........<_•--....... ... EH 13 .2h 1.-69 Rev. 5M SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3M