79-43 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: , / FOR OFFICE USE: !/ APPLICATION FOR SANITATION PERMIT --------•--- - --------- Permit No.../.., .�-3 (Complete in Triplicate) Date issued__. --------------------------------------------------------- This Permit Expires 1 Year From 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 Regulations: JOB ADDRESS/LOCATION...... .... ..:. -----..CENSUS TRACT................... ......... --- Phone - -- , Owner's Name -7 ----- Address------ .,8.&; "---.------- l - -- ... ---- ...... "- -----------City------------- Z•P--------- ----------- ------- 61 Contractor's Name......-- - --- _ •-- - ------License #-5-�� G�J-L Phone-f E � Installationwill serve: Residence ` Apartment House Commercial ❑ Trailer Court ❑ � � p ❑ " . r Motel ❑ Other-.....--------- ------ �J Number of living units:....... _ -__Number of bedrooms---.---- arbage Grinder.-..-...--:-Lot Size__................. ........................... Water Supply: Public System and name-- --....--_- -/l/ �✓ .'�.... -------•---------------------- --.."....: -----Private ❑ Character of soil to a depth of 3 feet: Sand ❑ 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,[ PACKAGE TREATMENT [ } SEPTIC TANK [ ] Size ----------------------------------------------------------Liquid Depth...:`.-------- Capacity_........ ......Type---------_----------Material--------- ---------------No. Compartments.... Distance to nearest. Well-------------------------"-- -- - ---------Foundation-•---_- -- . ...........Prop. Line......--------------- ---- LEACHING LINE [ ] No. of Lines ---------------------Length of each line.....-------------------------Total Length .- _----_ F ..... 'D' Box...........::Type Filter Material........ - -. Depth Filter Material-- ----------------.---------------•........--....--- ------ i Distance to nearest: Well--------------- -----------Foundation_---------------------- .Property Line_------------......----......... • SEEPAGE PIT { ] Depth--------------bi'ameter---------.---- ---Number-------------------.----..------ Rock Filled Yes E-] No Water Table Depth. ---------------- Rock Size--. - �. Distance to nearest: Well-------------- ----- ---- .--------..-.Foundation------- . . ......._.Prop. Line-------- REPAIR/ADDITION {Prey. Sanitation Permit#"------------------------------- ...........--.Date...............--------------------- ......... Septic Tank JSpecify Requirements)__ J _---- ................................ Disposal Field (Specify Requirements).- �- _--- ------------- ------ --- - ------------- --------------------------- .............................. -- -----.......-------------- ----------------------------------------------- (Draw existing and required addition on reverse side) I hereby ceYtify 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 licensed agents signature certifies the following: It I ! "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 become subject to Workman's Co pensation laws of California." Signed.......... Owner ".....Title--- --------------------- ------------ ----- -------- ------------ --- By ••. • 1 (Mother than owner) # F DEPA M NT E ONLY APPLICATION ACCEPTED BY . 'i!?""^ 7DATE -I-� 7 ....... .- -- DIVISION OF LAND NUMBER----------------!._ - ------- ADDITIONAL COMMENTS.......___------------------ -------------------------------------------- ---- - - --------------------------------------------------------- -........----. ---------------- ...--------- -----------•-•-•- Date._'` � .. . FSS 21677 REV. 7/ Final lnspecilon b HEALTH DISTRICT 76 3M EH i3 24 SAN JOAQUIN LOCAL H � �