76-821 - Laserfiche WebLink

Home Browse Search

f FOR OFFICE USE:_ " .. APPLICATION FOR SANITATION PERMIT ............... ....... .__...................-----•--• . ..............._..... 1Comptete in Triplicate) Permit No This Permit Expires 1 Year From Date Issued............. Date 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 No. 549 and existing Rules and Regulotions. JOB ADDRESS%L oN ref:... .__.. .. .. �.... -........... ..... ...............CENSUS TRACT ......... Owner's Nome . . - -... .-........-----•. ................•----.... ..- .... ........Phone .. -..... . ._- ... ............... ityAddress Contractor's Name ....... ... ...... .............. ..------------------------License # Phone _.......__............ ....... Installation will serve: Residence Apartment House❑ Commercial [-]Trailer Court a Mote Other of livingunits: Number of bedrooms ....0.....Garbarie � . --------------------------- Number Garbage Grinder -,.._....... Lot Size ...�%�-Q�-�-��:�............. Wafter Supply: Public System andname .. ---...........:................. ...........................................Private I Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat❑''' Sandy Loom ❑ Clay Loom 9 Hardpan ❑W lAiiobe M' _FfIl 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.) r NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK,[ ] Size------------------------------ ---- ----- --•-- Liquid Depth ..........................ks : Capacity . Type:------------......... Material--- No. Compartments ......................Q1 I Distance Ito nearest: Well . .....-...-........................Foundation ..................;..; Prop. Line ..................... S LEACHING LINE [ ] No. of Lines Length of each line ......- Total Length ....__......................00I D' Box :...- . Type Filter Ma tenal --------------------Depth Filter Material -....--.---.-.-....._-----.------ .......... Distance to nearest: Well ...................a.... Foundation Property Line _.._.-..-_._--..._-_-_:- . SEEPAGE PIT [ j Depth-4 ..p. .=Diameter .................... Number - Rock Filled Yes ❑ No (:Ir r Water Table Depth ...................... =---------.-Rock Size ..----•----- ---- Distance to nearest: Well -------------------------------- ..Foundation ._..-----..- --..... Prop. line ...................... {� REPAIR/ADDITION(Prev. Sanitatioh.Permit-# ........ ............... Date ----.----_-----.--.-.-------------} ESeptic Tank (Specify Requirements) ._....:. ........ .................:`'---------i ------.............................. -- ------ .....-----•----- Disposal Field (Specify Requir ments) .� �f-, �- - .-------. '--� �c---- �,�� a �,�---------.....q.y 417 ------ R �l .......... `{ (Drclw existing and required addition on reverse s i d e I I hereby certify that I have prepared this application and that lhe,work will be done in accordance with San Joaquin County Ordinances, State Laws, O';d Rules and Regulations of the Snn 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 shell not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed .............. ..... ) ;.... Own .... ... . —r_1 ................... .... ....... .... ... (If other than owner) FOR DEPARTMENT USE ONLY _ APPLICATION ACCEPTED BY ..... l -.. ..... ..... ...--- ........:............ DATE F BUILDING PERMIT ISSUED ...........:... .... .:. ..... ------ ---•- ' .... _...-•--- -- ---....DATE ._....,.......- -.......................... ADDITIONAL COMMENTS ..... ............................................................................•. _..:_.....--•---..-•,...--------------------,. . ..... -- -------- -------------------- .... ...... ----- . ------•------ r _.._..-------- . Final Inspection by: . . Date 5 �.�37. ..................'' SAN JOAQ 11N Lf At..+rA�LTFI DISTRICT E_ H_13 24 I.-AR Qa,. 5M 7172 3 K