75-741 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: .t APPLICATION FOR SANITATION PERMIT ..................... iCornplah in.Trlplicahl Parnnii No. ..................... . This Permit Expires t Year From Doh Issued 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: JOB ADDRESS/LOCATION .......... �C3 CENSUS .QCT Owner's Name ? one -_' L Ph ,�� —L Address /!�� .']. f'1�1� .... •. .. -. / ..... city ?,�/_ ......... 1 Contractor's Name -.L2/ ...... /2 /- _........................................License,lt! In/..sem__.... Phone Installation will serve: Residence Apartment House[] Commercial❑Troller Court ❑ Motel ❑Other............................ _.... Number of living units:----- .... Number of bedrooms .- ....Garba_ge Grinder _..._.---... Lot Size �l��'r�(��c�' __ Water Supply: Public System and name ............. i ...---....-•••................_...••---._................_........._......._..._.Private,[J�- Character of soil to a depth of 3 feet. Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ 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.) NEW INSTALLATION: (No septic tank or seepage pit permitted If public sewer Is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK ] S ize-------- .. Liquid Depth -•............. --1........._ -_------------ Capacity -------------_---- Type ------... aterial........ . ----- -- No. Compartments ...................... � Distance to nearest: Well - -•....... ............Fo dation ......___............. Prop. Line .._._........._....... G LEACHING LINE [ ] No. of Lines ------------------------ h a each line. _- ... . .... Total Length -------.-_-• 6 V Bax ............ Type Filter l ................ Depth filter Material ............................................ Distance to nearest: Well .... ......... Foun ation ._...........---•------. Property Llne ...____•--......,....... SEEPAGE PIT { ) Depth -------------------- Diamet1. N ber ..............._....--__---. Rock Filled Yes ❑ No �]---- Water Table Depth -•---•-_•- --- ---- -• - ...__.Rock Size ....Distance to nearest: WellFoundation---•-. ....----•- ......---•--•--..... Prop. Line -----------_----...- RI:PAIR/ADDITION(Prev. Sanitation Permit# ...........--------_ ------ ............... Date ..................................I Septic Tank (Specify Requirements) .................... ..... ..... .. ..... ...... _ ... Disposal Field #Specify Requirements) ...... .__ -•- -..0 - ,1. 1 (�! _ __ l -� 0 - ltd � � � `--------•---------• --•--......--•---------•-------------------------------- ....................... --------•---•--------------- -- .......-......................................................................................... _______ (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 Heal&DIstrict. Hama owner or licen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is Issued, l shall not employ any person in such :manner as to become subject to Workm Compensation la s of California.,, Signed ...... _. Owner BY if - ---------owner) ��C---- •------�---•-•.... Title -------- ------ ......................... .......---- .......... (if other than owner) IL 1k FOR DEPARTMENY USE ONLY � APPLICATION ACCEPTED BY _-- • . ------------- DATE ..__._.. -- - ?._....---,: BUILDING PERMIT ISSUED DATE ....-................................ ADDITIONAL COMMENTS .----.___----.. ----------------•-------------• ••--------------.------.-.._--•-•................................-........... .......... -- -- ---------------------.- . .... •- ........1 ------------ Final Inspection by: ..-.------- - - - ---• -•---------------•-----_--- .................Date -..�.. .�.��.. EH 13 21a 1-68 1 5M SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h3M