74-349 - Laserfiche WebLink

Home Browse Search

FOR-OFFICi' U5E:-µ APPLICATION FOR SANITATION PERMIT Permit No. ---- --------------------------------------------------------- (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: s � y ---- JOB ADDRESS/LOCATION ._-- +-- -- ----WI-LL 11/i/f �--------------------------CENSUS TRACT --_-------- -- -- �— ) Owner's ame � = ----- �� :CIBC _/-- -------- ------ --------------------Phoney - 7 Address ._ . � --------------- Contractor's .-- F--------� -------------�------- ------- •--------City Name � � --------------------------License Y3�� -- Phone & k Installation will serve. Residence [R Apartment House[] Commercial m❑Trailer Court Motel ❑ Other -----------------------------------I-------- h Number of living units:-----�_---- Number of bedrooms { -____Garbage Grinder _ LotSize ____.�T }�'------- Water Supply: Public System and name ------------------------------- -------------- ----- -------------------Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam Clay Loam El „ Hardpan ❑ Adobe ❑, Fill Material - ----- If yes,type --__ _R----______-- (PI'ot 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,) _______ uid-Depth --- ----------- PACKAGE TREATMENT SEPTIC TANK'[ . _______________ --- � ., Capacity ----------------= Type -------------------- terial--------------- No. Compartments -----------------=•--- Distance `V � to nearest: Well --------------------- --------------Found ion ---------------------- Prop. Line ----------------___.-.. 1 4 LEACHING LINE [ j No. 1of.L�in�s - ------:-= -__-Length . -.each lihe��.�-'_=_F f--MY=.---..----- Total Length :--------------------------- { D'4 Sox ------------ Type Filter Materi -------------------- epth Filter Material -----------------------------------.--------- Distance to nearest: Well __________ ------------- Foun tion ------------------------ Property Line ------------------------ ' SEEPAGE PIT [ ] t Depth ------------------ _ Diamete ________________ N mber ---------------------------- Rock Filled Yes ❑ No C] `Water Table Depth ---------- ------------------------ ------------Rock Size ----------------- -------------- Distance to nedrest: Wel ---------------------- ----------------Foundation ------ Prop. Line ----------------_---- REPAIR/ADDITION(Prev. Sanitation Permit;# _ ------ --------------- ------------------ Date ------_--------------------------- Septic ----------------5e tic Tank (Specify Requirements) --------`---------------------------------------------------------------------------•---__,------------------- ------------------------------- ;Disposal Field {Specify Requirements) !x� - ------– ------- y} ----------- 0,�------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ - i {Draw existing and required addition on reverse side) -w I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin ^6unly Ordinances, State haws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or liven- ? 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 Workmaq's Compensation laws of California." Signed - Owner - - - ----- --- i - ------ Title ---- ----------- -------------- --------------------- ---- ------------ (If other than owner) FOR DEPARTMENT USE ONLY tet-- APPLICATION ACCEPTED BY l i" �= ` = '' ---------- i ^�. DATE ---- ---�-,� _ _Z. ----- i �...,,_ ,_ v BUILDING PERMIT ISSUFD---------------------------`=---------------------•---------- --------------- -------------�-----\------DATE.. ---------------- ADDITIONAL -- T ADDITIONALCOMMENTS ----- --------- ------------------------------------------------------ -------------- ---------•-------------------------------- ------------------------- -- -------F= -------------- ------------------------------- --------------------------------------------- s jj%% f � -------- _Date ---------- -- Final Ins ectiori b % ______ _ _ -_ -�-- p Y } SAN JOAQUIN LOCAL HEALTH DISTRICT } E. N. 9 1-'68 Rev. 5M