74-461 - Laserfiche WebLink

Home Browse Search

..ir FOR OFFICE USE- APPLICATION FOR SANITATION PERMIT (/ .......................... Permit No/..T:.�.7 ?.I Momplete in Triplicate) .............................................. ... -This Permit Expires 1 Year From Date Issued Date Issued . . �1:.?.. Application is hereby made to the San Joaquin Local Health District for a per 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 ...................... -i.......... _. ...........CENSUS TRACT ...............•.......... PhoneOwner's Name ................ .1^... ._.: ,5* ' Address .---.--....------... 7 . ....... . . . . ......... ...... City .rc . . ..... Contractor's Name ._._ ...... License ,# : ._ :. Phone .............................. Installation will serve: Residence ®'Apartment House Commercial ❑Trailer Court 0 $ Number of living units:../....... Number of bedrooms ...-.Garbage Grinder ....... Lot Size ............................................ Water Supply: Public System and name .........................................................--........................................... .........Private Character of soil to a depth of 3 feet: Sand'[]`-Silt[] Clay ❑ Peat❑ ' Sandy Loam jZ Clay Loam ❑ Hardpan ❑ Adobe E3 FiII Material ............ If yes,type ............. .............. F s (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 sebpage-pitpermitted if public sewer is available within 200 feet,) PACKAGE TREATMENT SEPTIC TANK,t ] Size.........................................•...... Liquid Depth ...................... �, I Capacity • \Type ....: •--... Material...................... No. Compartments ...................... O 1 Distance to neareat:�Wel) ...._...i....._.�.......... ..Foundation- ... Prop. Line i LEACHING LINE [ ] No. of Lines ...............`.�.._-.- Length of eacheiine............................ Total Length. ...___..._................. O D' Box ............ Type Filter,Material t`- Depth Filter Materia! i Distance-,tp nearest- Well ........:............... Foundation_...,__..__.:_.._ ._._ Property Line . SEEPAGE PIT Depth _..._�_ .��4Kki._.. Diaimeter --•---------- -�Nu4mber ......... y s .... hock Filled Yes ❑ No (] Water Table Depth—A....... ............•----..................Rock Size . 1 - Distpnce to nearest: Well`s - =�• "4z Foundation .................... Prop. Line . .... ............•-•-................. ................. REPAIR/ADDITION(Prev.i5anitatiari Perm' # _ ' ` ` �..:.t�� Date .......:..........................) j .........•- Septic Tank (Specify R;qu:reman s) ..... Y. .l_ f''Tib .:.. --------•......------............................................ . .... Disposal Field (Specify Requirements) ....... ................r�l..r:. =_ '----.............................................................................. ------------------------------------ .. .-_----- -------- - ....... . -----------------------------------••--- .......... --------------•--------- 1i 1_.. (Dra"w3-existing and required addition on reverse side) I hereby certify that I have prepared this application and that We work will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and jlRegulations of the3San Joaquin local Health District.iNome owner or licen- I'f sed agents signature certifies the following: '«---------- --' "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 sub*0djoWorkman's Compensatlen laws of California." z Signed •---...---- - - - -----•----••-•--=_..,i................ ......•-•----•----. Owner By ___ __�_ .�._.,.... ............................... . ```---:•._.. . Title .. :........... (if other'than.owner) OR DEP .RTMENT USE ONLY -.. APPLICATION ACCEPTED BY . :c��•`=:"� ..:..........�.jy.:._...::.. DATE ............. ........Y.-.... �� BUILDING PERMIT ISSUED ........................................... ._.,__. ... DATE .................... ..• ADDITIONAL COMMENTS ..------•.................•--....----------------------------....................................----••-•--- ... . ....................-.............. .. ......................... .•-------------•---.......-----....... ............ -•-•- -- Final Inspection by: ,/ ......................................Date .... ..... ../. . -5.0.'........ SAN JOAQUIN LOCAL HEALTH DISTRICT _