74-477 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: Permit No. APPLICATION FOR SANITATION PERMIT </ //7 7 1.. ....••---•. ...-""...................... (Complete in Triplicate) �. Date issued 7... This Permit Expires 1 Year From Date Issue r _ , Application is hereby made to the San Joaquin local Heolth'Di strii:t-for a'permit to construct and install the work herein nce with CountyOrd] once No'. 544 and existing Rules and Regulations- described. This application is made in complia� .._-........... ........ .....CENSUS TRACT JOB O.. =. �C ./P�-�fJf��-�•��l' due ..... ....'...._.`c. - ur:.... h..o.. n..e..... .................�.V.i. .................... ................... Owner's Name .........• ........ Address _..- ` i .............. city. : a Contractor's Name ---- � �:---------::.. -.License # a,�l .Ph°n ` , I installation will.serve: v Residence ❑ Apartment House') Commercial :❑Trailer Court _Motel ❑Other -------------------------------------- s� _- -_. ot Size . -.' ----•• Number of living units:_`- dumber of .bedroom�;f, .Garbage-Grinder ------------ LPrivate ❑ -- ..... Water Supply: Public System and name ---------------•:,---=------ - Clay Loam Character of soil to o'depth of 3 feet: Sand Silt❑ lay ❑ Peat❑a Sandy Loam (] Y f y e ............................ ' Hardpan:[]- 'Adobe�( -Fill Material _..._�_.._.._ If es,type . I tc. must be placed on reverse side.) (Piot plan, showing size of lot. loc8`tion�of. system in relation to wails, buildings, e NEW INSTALLATION: (No septic tank or,seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK'S ] Size------....-................................. Liquid Depth .......................... .. Moteria6 ---- No. Compartments ......................•O _1 a Capacity ............... Type ., ... ..Foundation __. Prop. Line ................. 'Distance•to nearest: Well •------•------..... V ' .... Total Length LEACHING LINE" :=No. of Lines ..-----..":----.--"--... Length of each line........................ . 'D' Box ............ Type Filter Material ....................Depth Filter Material -___. ------------ - f Distance to nearest: Well ........-_••:-- --•= Foundation --------------•-••. -• Property Line No ❑ Diameter Rack Filled Yes ❑ I SEEPAGE PIT, [ ) Depth � ...:.........•-- Number ......----•--•-------••--- Rock Size Water Table Qepth. ; .....__... ----••-•--•••. --------------------------------- IC _Distance-to nearest:.Well .................•- :-•-...Foundation .................... Prop. Line •-10 _. . Date -----•• _ �:. REPAIR/ADD ITION{prev. Sanitation Permit ----•----- --- . . s Septic Tank (Specify Requirements) "."_•;--•............ .. .�_-. . . 01 Disposal Field {Specify Requirements)i •--- - � :.....: . ._"----- ------------------- � , /e r -----------------................ ------------------------ ._.. . (Draw existing and required addition on reverse side) I hereby certify='thpt1I have prepared this Epp kation 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 lican- sed agents signature certifies the following: pe :is.issued,.I shall:not employ any, person in such�imanner "I certify that in the perforrntince+of the work for which"this p �. as to become subject to Workman's Compeessalion laws cf Califoinia:" r ne..... O wf ................ Signed _ -, - . _ ::-:::...... Title r � By t If other t a'n owner) , 1 w.- .wFOR DEPARTMENT USE ONLY X APPLICATION DATE .�8 .� -•� -------•-----•-•---- ION ACCEPTED BY =-' ��'� _ .. ..... - ..DATE BUILDING' PERMIT ISSUED ......:........................ .:..........---•--•--•--.....__..'...:...._..._....... ..... _._. ADDITIONAL COMMENTS .......................... __ . ..- .._.. ........ ..... ............ .•-•- _./.._ --`�... _. ...� -- `•.:. ... ::. ................................... ... ... ------ Date - -_ Final Inspection by: • ••--------- SAN JOAQUIN LOCAL HEALTH DISTRICT 71723 ,4