72-778 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ------- ------------------------------ ------------- � Permit No. - � (Complete in Triplicate Date Issued -------------------------------- This Permit Expires 7 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to con-'st.Noland install the work herein described. This application is made in compliance with County Ordinance No. 549'and;'existing Rules and Regulations: , ----- ::_CENSUS TRACT ----------------------- JOB ADDRESS/LOCATION - � /r{rd / ol Owner's Name - r`� = Phone one ---------------------•--- ---------- Address ----- �-------------------------=------------------------------------ ------------ City r License � - Phone Contractor's Name __ ----- {' - --- - Installation will serve: -------------------------- Residence Apartment House❑ Commercial ❑Trailer Court ;❑ Motel ❑Other --------------------------I" ---------_- 1. L.�, i Number of living units:--/---- Number of bedrooms --------Garbage ender f Lot Size __�._ '- -r --------------------- Water Supply: Public System and nam:--------------------------------------------------------- Character / Private ° ----------------- ��3 Character of soil to a depth of 3 feet: Sand❑ . Silt❑ Clay ,❑ Peat.Q Sandy Loamx• Clay Loam 0 Hardpan F-1Adobe '❑ Fill Material ------------ If Yes,type ---------------------------- (Plot plan, showing size of`lot, ilocation 4of sys#em in relation to wells, buildings, etc� must be placed on reverse side.} '14% } r NEW INSTALLATION: I(No septic tank or seepage pit permitted if public sewer is available within 200 feet,} PACKAGE TREATMENT [ ]' SEPTIC TANKQ' Size- , ' ( �f --- .----'-- Liquid Depth _, __---------.----- . t , ----- No. Compartments --- -----• •-•• C Pcity/.- yP Material -4 -- i . .a a11 t Type .T- -Foundation -x --------------- Prop. Line - ----------- _ �= Distance to nearest: Wel +-------------- LEACHING LINE " 'No. of Lines --- Length of each line__ - -------------- Total Length -------------- LEACHING Box ' Type Filter Material/,&, ,�/ Depth Filter----------- Material ��------------ ---•• •----•- Distan to _,��nearest: Well -- !/_ ------- Foundation Property Line 41,;:1------------------ ----- r ` Rock Filled Yes No i❑ Diameters Number _.______ .� �tT [ � Depth -�-�- -- - --- � ��' - � -------- ---- - /l is r- Water Table Depth _�_ �� ---------------Rock Size -- -- f � - -- ------------------ j �g. ,....es ��-------- Prop. Line _�---------------- Distance to nearest: Well -----/- ________________Foundation REPAIR/ADDITION(Prev. Sanitation Permit=# -------------------------------------------- Date ----------------------------------j I Septic Tank (Specify Requirements)# _-------------------- ------------ ------------ - -------------------------------------------------------- -- Disposal Field {Specify Requirements} __________-_ ------------------- --------------- -- -------------- -------------------------------------------- ---------- ---- ----------- --------------------------------------------------- - ------------------------------------------- -- -------------- --- -- - - - = -------------------------------------------------------------------------------------------- -----. S ) (Draw existing and required addition on reverse side) e .•. I herebyy reify that I have prepared*this application and that the work will be done in accordance with San Joagv�n CountyWdinances, State Laws, anOules and Regulations of the San Joaquin Local Health District. Home owner or licen=" sed agents signature certifies the fo�wing: i "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's,Compensation laws of California." s f Signed ------ ------- -- -----�--- Owne By - = Title ' (If �an owner} 1 , FOR DEPARTMENT US ONLY 1W. QATE -`7- 3/ APPLICATION ACCEPTED BY - --------------------------------------------------------- BUILDING PERMIT COMMENTS ISSUED ---------; --------------------------------------- ------- __DAT - ADDITIONAL1t-- ---------------- ----------------------------------------------------------------------------------------------- ----------------------------------------------------------=---------- ------ -- ----- --------- ---------------------------------------------------------------------------------------------------- ------------------------------- -------------------------------- -------- -----_ -- -- -------'�------- ------- -- ------- --- ----------- Final Ins ection b _ � -------- ------------- Date 1J- --- } SAN JOAQUIN LOCAL HEALTH DISTRICT E. H, 9 1-'68 Rev. 5M -�► ..r.-�_