76-76 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE- APPLICATION FOR SANITATION PERMIT r y 6. 76 ........ . ._ . ..................... (Complete in Trlplieatel' i .A _ Date y— ermlt' o This Perinit Ex (rest Year Froin Date lssued 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: / p OB ADDRESS/LOCATION ..............:... ....................CENSUS 'fPACT ................:......... ........... .... Owner's Name f .P------� .............................. . ....Phone .................. Address _. �f .. ... �- Ciry,. ',�_ ...._... Contractor's Name ......�.a - fC/t./ .......................License # 271.iO.. ;?. Phone E -Z� Installation will serve: ResidenceApartment House E] Commercial oTraller Court 0 Motel ❑Other ............... .......................... j Number of living units:_.._..!..... Number of bedrooms -- ---Garbage Grinder/lf =-- iot`Slze'.��1� __.1. ..> -........ ... Water Supply: Public System and name ...41_44X.......�5��..... ......:..... _. ...:Private Q Character of soil to a depth of 3 feet: Sand'E] Silt O Clay ❑ Peat Q Sandy Loam fl 1 Clay Loam ❑ ' Hardpan ] Adobeg Fill Material ............If yes,type............. ............ I (Piot 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'240 feet,) J PACKAGE TREATMENT [ } SEPTIC TANK f } ... FLiquid Depth ........•................ Capacity ... Type Material................. -iNo. Compartments �. Distance.to nearest: Well ....................................Foundation^y_............... . Prop. Line __-_ Length of each line_- ---= Total Length .....---_...................N LEACHING LINE [ } No. of Lines ---------------•_-.- g - - g 'D` Box y Type filter Material .................---.Depth €ilter Material --:............:.......................... Distance to nearest: Well --- _------...... Foundation .........:..........�_' Property Line' .........................� SEEPAGE PIT ; ] Depth ........... Diameter ..........:..... Number .... ........................ Rock Filled, 'Yes Q No Q- I Water Table Depth b _- • } _ ..Rock Size . Distance to nearest. Well -----•------•------- ------••-•-----._._foundat€on ..__.....---:..... '._ Prop. Line ................... REPAIR/ADDITION(Prev. Sanitation Permit# ....---... ....... 1 Septic Tank (Specify Requirements) --°`---....._.:, .....•... ..... .....* - ........................................... •--- I Disposal Field (Specify Requirements) " ' �' r .--.. 06. :.._ ' .-r'...._. .................. -----._..•--_:........................ .. (Draw existing and required addition on-reverse-side) I hereby certify that 1 have prepared this application rind that the work willfife dare in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the 'San Joaquin Local Health,District. Hoene owner or licen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit-is-lssued,'l shall not employ any person in such manner as to become subject to Workman's Compensation laws of Californla." Signed ............................ .... .........._-- Owner 13 `--••---•-•----- -'-- . Title ......................... Y ------------------- --- (if oche n owner) ; FOR DEPARTMENT`USE ONLY APPLICATION ACCEPTED 8Y. :... ............................:. DATE :.:._........._.... 7 ...._.._..: BUILDING PERMIT ISSUED ... ::.............•......._.._.._--. ............. __........ ...............-....... -...............................------- ------------------------------------ ----------•--•----------------•-._..----------- ----------- ------•- .........._..-------- . . . ----...-------•-------------.... :•_.__......._. ----- -- ------ -------------------- ... Final Inspection hy: .: �?r2.1 ,. ._.._._..Date 1.- 4 a ............. EH 13 24 1-68 V- 5M SAN JOAQUIN LOCAs. HEALTH DISTRICT 8/7h 3M