71-582 - Laserfiche WebLink

Home Browse Search

_ y ' FOR OFF.14_. a> - 1 API'.,�ICATION FC�iR SANITATION- PERMIT „ -- ---------------------------- R " (Complete in Triplicate) ".Permit No. This Permit Expires i Year From Date Issued Date Issued _2011>171 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 Count Ordinance N Y e o. 549 and existing Rules and Regulations: JOB ADDRESS/LOCAT N -------- -------- -------&4 _ 're 0-4 - - -- --- --------------- ----------------CENSUS TRACT Owner's Name v - --_n----------------.-------------- Phone Address - �� . CifiY - Contractor's Name _______ _.__---_.License #p Y123 Phone 7�C�-��y-_ Installation will serve: Residence ❑ Apartment House❑ Commerciaxrailer Court Motel ❑Other --__------"_______________ • -------------•---- Number of living units:------------ Number of bedrooms =___________Garbage Grinder ------------ Lot Size Water Supply: Public System and name ______________________ ----------I Private ---------------- ------ - Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobex 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.} V l NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,] (A PACKAGE TREATMENT [ I SEPTIC TANK;[ ] Size------------.------------ '-------------------- liquid Depth Capacity ---------------- Type -------------------- Material---------------------- No. Compartments Distance to t nearest: Well ------------------------------------Foundation --------.------------- Prop. Line ---------------------- LEACHING LINE [ ] No. of Lines ------------------------ Length of each line-----E____"_---------_-_--- Total Length ---------"--- 'D' Box ------------ Type Filter Material---------------------Depth Filter Material - - ---------------------- Distance to}nearest: Well -------------------- --- Foundation --- --------------- Property Line - ---- SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No i❑ Water Table Depth ---------------Rock Size --------------------------•-- Distance to nearest: Well ----------------------------------------Foundation -----------_-----_-- Prop,Line .--------------•-•---- REPAIR/ADDITION(Prev. Sanitation Permit# .------------------------------------------- Date ______-_________-__-_.- ) Septic Tank (Specify Requirements) ____________________________ -------------------------------- Dis asa,, Field (Specify Re uirements)j _------------ ------- --------- ------------- 1 --- - --- --- --- ------- ------------ ------------------------------------------------------------ --------------------------------------------------------- raw existing and required addition on reverse side) i 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 )item- sed agents signature certifies the Following: "I certify that in the perFor once f t e work for ch this permit is issued, II shall not employ any person in such manner as to be a su *eft to o ma 's ompen3atidt�a sof California." Signed _- �✓_ ------ —__---:_____ Owner x -- BY' Title ------------------ ------------ {If o an own FOR DEPARTMENT USE ONLY s 3 ,APPLICATION ACCEPTED BY ---- ------ - -------'- ------------ s BUILDING PERMIT ISSUED ------ - = DATE ------------ ---'--- --------------------------- DATE DDITIONAL COMMENTS ___________.__ t ------------ --------------------- -------------------------- -------- -------- --------°---------------------------------------------------------------------- ----------------------------------------- Final ------------- ----------- ---------- ---------------------------- ------- ---- --- --------------------------------------------------------------------------------------------------------- ------ - -- -- Final Inspection b �q q- ------------------- P Y ---------------------------------------------------------- -- Date �t - ------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT -E. H. 9 1-'6$ Rev. 5M