74-594 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No, (Complete in Triplicate) This Permit Expires ] Year From Data issued Date Issued ................ 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 corriplionce with Courity'Ordnance No. 549 rind,existing Rules and Regulations. - �- ?�1 � JOB ADDRESS/LOCATION ......:..�._....1._?�-............ . ....•----- . ........ .................CENSUS TRACY .......---....:......�:.. Owner's Name :� � .. ...::... --•- ---Phone .................................... .r ....... _ /l. .. ................I._.......... . Address ....................... .16/. . .......... City _. ..--------..--- ...................-•----•---..............•..... Contractor's Name ._-., ..... ��Lent ................t................License # P?O-/ tV. Phone' ��'-5 . �fi�. Installation will serve: Residence House.❑ Commercial ❑Trailer Court fl Motel ❑Other .-•............... .................... Number of living units,---,/--- Number of bedrooms .,3......Garbage Grinder ._ ... Lot Size .... ��../..'-'. ......•......• Water Supply: Public System and name ...................... .....................................•......Private i Character of soil to a depth of 3 feet: Sand Silt❑ Cla'y Peat C] Sandy Loam 0 Clay Loam ❑ Hardpan ❑ AdobeFill Material ...AI0_ If yes,type ............................ (Plot plan, showing Ysize of lot, location ofsystem 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[ ] Size................................................ Liquid Depth .......................... Capacity -------------___ Type .................... Material...................... No. Compartments ..................... Distance to nearest: Well ....................................Foundation ...................... Prop. Line ...................... LEACHING LINE [ ] No.' of Lines ........................ Length of each' line.............................. Total Length __._............-•-----..,_. 'D' Box ...... Type Filter Material ..----------_-----Depth Filter Material ............................................ Distance to nearest: Well _ . . ................ Foundation ..........-------------. Property Line ............... SEEPAGE PIT [ ) Depth Diameter ................ Number ............................ Rock Filled Yes ❑ No Water Table Depth I .............................Rock Size .................................. F Distance to nearest: Well .....................:.................Foundation ----..... ........... Prop. Line ..................... REPAIR/ADDITION(Prev. Sanitation Permit# i .........--.....:.................••---•---• Date .................................. ) Septic Tank (Specify Requirements) .................:..---- ..................................... ........... ....................------c................. ---•-- Disposal Field (Spec'fy Requirements} .... , - . ... ............................... (Draw existing and 'required addition on reverse side) I hereby certify that I have prepared this application and that fthe work will be done in accordance with Son Joaquin County Ordinances, State Laws, and Rules and Regulations of tiie San Joaquin Local Health District. Home owner or liven. sed agents signature certifies the following: I "I certify that in the performance of she work for which this per�it is issued, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of Cali(ornia." Signed _ Owner By ........................... -- ...1.�')• ...... Title ......61. (If ofjerPhon owner) FOR DEPARTMENTI USE ONLY APPLICATION ACCEPTED BY ....... ....... ---••------------ E...-----------------•.................... DATE ..... n!..... 7. .......... BUILDING PERMIT ISSUED ................................DATE ADDlT{ONAL CO MENTS ... ..1. , ........'..............:...................).:_.......... : :...... ............................._......... r:.. .. .. .. ... . .... Fina{ inspection by: . f �.....:....... ...�......_.:`�=.:. •-_-_---..__.--_-- ............. Date ....�..�. __7r ..........._.. SAN JOAQUIN LOCAL HEALTH DISTRICT q 3 m y, .s 74 • .ten n___ cli 7/72