79-476 - Laserfiche WebLink

Home Browse Search

FOR OFFICE U5 - FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT �,�" Permit Nol..!_�........................ ..[-�-;�--- ..-- (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: CENSUS TRACT. JOB ADDRESS/LOCATION.... . - _Phone...-=-- •-- --- --- ---- Owner's Name.-- ...... . ... - E Address: .1�.- Zip Q Phoned ) �'�'� -- License # . -[✓� ✓� " Contractor's ........... . . - ---------- Installation ��--- -- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other--.. . .. --- ---- ------------ Number ---- - jSize � I Number of living units;..-_...1: __.__Number of bedrooms..--. .. arbage ri .._.-. ---Lot __-.. � l Supply: Public System and name_. -------- _ --------------- y._. -------- Water Prl a v t Character of soil'to a deptli'of 3 feet:" 'Sand ❑'"Silt'❑ Clay❑ Peat ❑ Sand Loam da; i_ 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.) sewer is available within 2Q0 feet,) NEW INSTALLATION: (No septic tank or seepage pit permitted if public se ` -- .-Liquid Depth.-Y.... ...-- % PACKAGE TREATMENT [;:] SEPTIC TANK [ ] Size . -�j- -- LO .� 99 L, . ...Material ..No. Compartments...', Capacity.��.o..-----TYPe ��- -. 7` �/- ••-- --- Foundation. Prop. Line... � ... ...... Distance to nearest: Well------�.rV---- --- - ------- P LEACHING LINE [ ] No. of Lines --_-_- ------.Length of each he, n . ----------•---.--.Total Length -/-- .-47_------- ... . D' Bo Type Filter Material.--.1 Depth Filter Material.../. ......................... Distant to nearest: Well.-J.-�---�--,-..- �;.Foundation--------------------- Property?Line..----------- !° — f ock Filled Yes No ElSEEPAGE PIT [ ] Depth..91. ....Diameter- -------- Number..:- ---- Water Table Depth---------=-----• '=- --._...---------.----- Rock Size__.._.. .. .+- Distance to nearest: Well.:-_'`��-�>�--.. �-3---- - ........Foundation �' -.Prop. Line ' ..------....Date .--._.:..................... ...._) REPAIR/ADDITION (Prev. Sanitation Permit#.--- -- -- ...... f i Septic Tank (Specify Requirements)---, -- ----- ; - Disposal Field (Specify Requirements)_' ..�........ -__ ------ ----------- ------ ------------------------------------ r h. ----•-•......................... --- ----- -------- ----------------- --------- Z _ _ .......... ............................................................... ........... ................... - ..... ........... ..-- -(Draw existing,and required addition on reverse side)_ 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 licensed agents i signature certifies the Following: ` "1 certify that in the performance of the work for which this 'Permit is issued, 1 shalt not employ any.person in such manner as to become subject to Workman's Compensation-laws of Ctilifornia." { Signed__._.. ----Owner [I �,of --�---- ...-�--- .....-- r ': _ -._....... Title ---- --------------- ------- -----� �--.-. 1 BY er tan owner) F R`DEPA T N 116E ONLY APPLICATION ACCEPTED BY ......_ .. n'"" - ...DATE ..... ? .. .... ......... DATE------------------------------- - -- ----- DIVISION OF LAND NUMBER.-----.-.-- ADDITIONAL COMMENTS°'--- ----- --------- ...... ....... ........... •---------- . ................... _ _ _ Final Inspeciton by: --------- -,^--- -------------- Date. F&5 81677 REV. 7/76 3M -EH 13 24 SAN JOAQU1N LOCAL HEALTH DISTRICT