76-975 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ........ ..................."................. APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. .....................� ..................................."..-_ __-...._.-- ......°:..............:......................... This Permit Expires 1 Year From Date Issued Date Issued ..............r.. . 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. 5.49 and existing Rules and Regulations: JOB ADDRESS/LOC Tl N ..-... 1 7f r -- ..---.CENSUS TRACT .......................... Owner's Name ... . Address ..............:.. L phone7.9 city - ----• ........................... Contractor's Nome . : _. ..:_--. `::License # Phone ............................... Installation will serve:. Residence [�Apartment,House 0 Commercial [)Trailer Court C] l Motel ❑Other ........:..:------------ Number of living units: . ,..(.-. Number of: bedrooms _... _ Garbage. 'Grinder..........-.._ lot Size .._-_,_:.................... Water Supply: Public System and name ------------------ ----;:• -f. �u.----'1� -�--------- Private ❑ Character of soil to a depth of 3 feet: 'Sand n Silt❑ Clay ❑ Peat❑ Sandy loam Clay Loam ❑ Hardpan ❑ Adobe ❑ 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,J PACKAGE TREATMENT [ ] SEPTIC TANK j ] Size............... Liquid Depth .................... Capacity Type ...........:.... Material -- .... Na. Compartments S [ ,) Distance to nearest: Well ..........•-------_•---Foundation .......... :... Prop. Line: ----------------- -J LEACHING LINE [ No. of Lines _ -: _ . _:. Length of each -Iine...'._...... ....:...... ... Total Length ............................ . "D': Box .__... Type Filter'Material -:_::_Depth ;Filter Material ------.:............. ri Distance to nearest:'Well _.`.........:....:.....:Foundation i. .............. Property line ........... SEEPAGE PIT O Depth Diameter :________________ _Number Rock Filled Yes ❑ No i❑ ---- --------- Water-Table Depth; ... .......................... ------------------Rock Site ............ Distance to nearest:,Well ..........-------------- :.'.Foundation— :-.-_-- 'Prop. line ...................... RiPAIR/ADDITION IPrev. San itation.Permit# -------- - ,............. ;Date _... ...... ------ --."") ?Septic Tank ISpecify 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 clone in accordance with Son Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health Distritt. Honie owner or.iicon- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued,"1'shall not employ any person in such manner as to become subject to Workman' ompensation•laws of California." r Signed .:......................... ... ...... "- By :.. Owner , « .+t%�/ .._:.pf1 .. title ............. ............... (If other than o ner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ....-----C,.. ----------------- .......... ----- ------ DATE ��- --- -------.--•-" •--------- BUILDING PERMIT ISSUED ...... ................ DATE _...._--..._..._...___....,__.._.-_......_< ADDITIONAL COMMENTS ........--•-----... --- ---------- -------"- ` _..._... ----------------------- --......------ -- --------------------- ---...---.........---..:._.....__.........----------------......--- ._..._..__"._--- ""__ ------ -- -- - - -- Final Inspection by: -.. .._.! ...... Date , _ -SAN JOAQUIN LOCAL HEALTH DISTRICT 4 E. H,13 24 1-'68 Rev. 5M 7/7:2•.3-M