76-43 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT --------•---- --•-...-------•.:............. Permit No. 74-5Z3 lComplete In Triplicate) _.............. ........................... This Permit Expires ] Year From Date Issued Dote 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 Na. 549 and existing Rules and Regulations. • r .108 ADDRESS/LOC 10 -, .. �C[ . CENSUS TRACT �....................... Owner's Name --- --- Phone ............................. Address - ...-...�.. / _.�;:1._ . _. _ . . .... .........:City .._. v . vd Contractor's Name _._.._.. . ---- __ ........ . . /'!�[r1�s.4 icon # /fV.s.�.. Phone ..... . Installation will serve: Residence Apartment House❑ Commercial❑Trailer Court ❑ gI Motel ❑Other ----------------- ------ -------------....... l Number of living units:.... Number of bedrooms _Garbage Grinder,............ Lot Size ....................................... .... Water Supply: Public System and nameI ----------------•------.....................................:............ . .._Private Character of soil to a depth of 3 feet- Sand 0 Silt Q- Clay ❑ Peat[ISandy Loam ❑ Clay Loam [3 Hardpan Adobe 0 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 I J Size...........................I..........- .:._. Liquid Depth ........................... Type .................... Material___________________ No. Compartments .....Capacity ----------------- Distance. ------------ ' Distance.to WJ nearest: Well -----------------'.c......._--------Foundation __-----............... Prop. Line ----.............;...: LEACHING LINE [ No. of Lines ------------------------ Length'of each'`line---------•------------------ Total Length ............... .. Type Filter Material Depth Filter Material Distance F to Well..._-_-___................ Foundation ..._.. ................. Property Line .................... SEEPAGE PIT { J Depth ---- - ------------- Diameter ................ Number ............--_------------- Rock Filled Yes ❑ No P ; Water Table Depth -----------------•-----------•---------------.-Rock Size •---------------•=-=--•-----•--- 1. Distance to:nearest: Well ----------------------------------------Foundation .................... Prop. Line ...........-----•••--� i� � REPAIR/ADDITION(Prev. Sanitation Permit{# ............. -------------------- ......... Date ---------------------.-.....--....) Septic Tank (Specify Requirements) -----•-- ----- ----- -- ---- --.� - ....................... Dis sal Field (Specify Requirements) •-�� -. -- - •_-- ---- ---- �t .__ebi • - - - --- -- --- 07--p--A- -- - - - - ........................ - ----.----•---------------------=----------------•--------------- , ( raw sting andfuired addition on reverse side) 4 I hereby certify that I have prepared this application and that the work will be done In accordance with San Joaquin T ` County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health,District. Hance owner or licen- sed agents signature certifies the following: •_ - - "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' ompensation laws of California." Signed -._..--. -------------- ••-••.r........•---•---- Owner BY - --<• -- -------- -----•---.....----- --- -- - -- ---- ---•--- ----- title ----. ...._. --- -•- ----- lif other than owner) FOR DEPARTMENT USE ONLY r APPLICATION ACCEPTED 8Y ----- • ------- -- ------• --------. DATA /... .�. . ..7 . .............: = BUILDING PERMIT ISSUED -- ----- ____.. --•--•.... .................-........ DATE -:....._......_..__....._.... ADDITIONALCOMMENTS -------------- ..................... ............................--------------------------------------...................... ........................ - ---------------------•-----------------inal Inspection by ----------•----._..- •-----•--- --------------- W ...F ._.: _._ __--•_______________•-----•-•-----•------------•---------------------- -�-.. �-- ---•---- Date EH 13 24 1-6$ Rev. 5M SAN JOAQUIN LOCAL HEALTH DISTRICT $/7lt 3M