75-1015 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE.. ;1w-.tel APPLICATION FOR SANITATION PERMIT 11� `� 1Complete in Triplicate) Permit No. .................. ........................................I..--- This Permit Expires I Year From Date 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. 544 and existing Rules and Regulations: s� JOB ADDRESS/LOCATION D..S_.54-_6_�_.7�-r.-��-- _.. .......... ....CENSUS TRACT Owner's Name .. ¢1�. ... •. ............phone -! 7 Address -----..I _D._r.. .... _ ... .. -. .... ity .. .................................... r- Con#ractor's Name __ ..._.:-- - -- --- - -- -- - - - - -- .......License# .......----•. ...... Phone Installation will serve: Residence❑Apartment House Commercial}]Trailer Court 0 Motel 0 Other Number of living units:_._._.. Number of bedrooms _ 7t/� .�_...__Garba a Grinder ____-. --• . Lot ze ._.�----•---------•..................... Water Supply: Public System and name ...................................�..__ /? 9 ..,. .. A..................Private ❑ Character of soil to a depth of 3 feet; Sand[] Silt❑ Cloy ❑ Peat Sandy Loam 0. 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 1f public sewer is available within 200 feet,) PACKAGE TREATMENT f ] SEPTIC TANK f4l ............................. Liquid Depth .. �,......._-- Capacity 1 gkv-__.----- Type I:! -. Material. No. Compartments �2 p ._.._..... ) Distance to nearest: Well . ........Foundation .....1.o.......... Prop. tine ...../ �..... ls'J LEACHING LINE 64 No. of Lines ------ ----------._.... Length of each 11.e..__. Q .......... Total Len th .......'..4e..`........6 re'D' Box ------------ Type Filter Material .. -• '- -.Depth Filter Material ...1.. .........I......................O Distance to nearest: Well _. . ..._ Foun ation .._1_ �..._....- Property Line ../,E.......... z ock Filled Yes No SEEPAGE PIT (�" Depth �4...... Diameter � �..--- Number .........___�---. - . 3 .. Water Table Depth ... _�..... -------------------- ---Rock Size 1- --?�• -. •---....--..... Distance to nearest: Wello N .. .Foundation Prop. Line / -------. .............. - REPAIR/ADDITION Wrev. Sanitation Permit# ............................................ Date .----.---.........-_------------} IJP • o Septic Tank {Specify Requirements) ----........... -----------------...........-...............-...........•.........r........................... •-.......................... 1 Disposal Field ISpecify Requirements) ........-----------------------_-- •---------_--------•- ..............................--................................ .. .........----------------------....---------------------- . -- -------•--------•-------------•••------------------------ --------------------•--•----------------------.......•................................•.................................-............... (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 Health:District. Hent* 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 beco a subj t o� Workman's C*pensati, wa f California." Signed _... _.. ----- -- f3 _.. - -----------------/.�y - - - --- ---•-- '' Title ------{If other than awned -•--- FOR DEPARTMENT .USE ONLY ' APPLICATION ACCEPTED BY .. DATE .. -- 2 '?.e__.��....- -------------- BUILDING PERMIT ISSUED ----------------- -- -----------------------------•--------------• •-----------•---- DATE ADDITIONAL COMMENTS ..-•------------- -----------------•--- ------ --------- ----------- ........ --------------------•-- -------- -•------__-------------------------------_..............------------ ........ --------------- --------------------.......... _... ----- -•----- ---------•�...----------- --.----------------• -.................................. Final Inspection by: ....--------- --- - - ----- -- --- •---_-.----•-----_---•---•-- -• ............................Date ..... -�.�3C� 7S---------- 13 1�' v• 5 SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M