72-479 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. -]_-�------ -------"-"-""- -- (Complete in Triplicate) - --------•-------- --------- Date Issued _ This Permit Expires I Year From Date Issue e work herein Application is hereby madthe Son Joaquin Local Health in compliance with County tO Ordinanceistrict for No. 549 and existing Rulestalnd hRegulat ons. described. This applicati o F __----CENSUS TRACT •--------------------•---- JOB ADDRESS/LOCATiO . - _ �" ��------ ------- ------- - --- 11-el-3--- Owner's Name --- ��----------------------- - - - -Phone-------------------------------------- ------------ - ------- --------•----------------- Address , /7----------------------------------------------------- City ------- ---- -- License - Contractor's Name ------- �� "� `�"� License # 13 Phone Installation will serve: Residence X Apartment House,[:] Commercial ❑Trailer Court '[1 Motel ❑Other -------------------------------------------- --- Number of living units:_____1__--- Number of bedrooms -----Garbage Grinder --------- -- Lot Size --- -`- -a–� - Private it Water Supply: Public System and name -------------n-_-:---- == --------------------------------- ------I---------------- Character --•--- -------- -- ---- Character of soil to a depth of 3 feet: Sand'� Silt❑ Clay E]- Peat❑ Sandy Loam ❑ Clay Loam D --- If es, a ---------------------------- Hardpan ❑ Adobe'❑ Fill Material __-_____- y 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 Size- -Ian x 9 `�- --------- Liquid Depth ___4-----•------- --- —0 i ] --- ------ " Capacity 1�- -d--- --- Type� __-- Material---�'`- ------ No. Compartments 1,3 ---5�------------------Foundation ----{-a--- ------ Prop. Line = ----=-------- i Distance to nearest: Well _______ � LEACHING LINE [� No. of Lines ------Z------------ Length of each line---------TV!------ Total Length ----DA---------------- ----- -----••------•- , 'D' Box __-_1------ Type Filter Material ------- -J�----Depth Filter Material ----- -`�--��-- S --- ..(_�--`--------- Property Line --- -------------------- C o_-�________ Foundation p � Distance to nearest: Well ____-__�_- $ r"" """ �� ______ Rock Filled Yes No �Q �E T fAl Depth --9---- Number !l — Wa#er Table Depth ----Rock Size -- --��----X- ---------------- _-Foundation ° --------- p Distance to nearest: Well _______________________ • -- -------- ------- Date --------- -------=-•--------------) REPAIR/ADDITION(Prev. Sanitation Permit# ------------------------- -------------------------------- Septic Tank (Specify Requirements ------------- ---- -------------------------------------------------------------- Disposal Field (Specify Requirements) -------------------------- -""--"--- ------"-"" ---------- - i ------------------------------------- ----------------- ------ ------------------------------- --------------------------------- - ------------------ ----------- ----------------- -=-------- ----------------- (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. Home owner or licen- sed agents signature certifies the following: ersan in such manner "I certify that in the performance of the work for which this permit is issued, I shall not employ any p as to become subject to Workman's Compensation laws of California." Signed --- -------------------------------- -----------. Owner - --- --------- ----- ----- - - --------- Title t (If other than owner) FOR DEPARTMENT USE ONLY I - -------------------- -------_-. DATE APPLICATION ACCEPTED BY _.---___`x-41--__ I ----------------- ---- -- ------------------ --DAT ------------------------------------------- BUILDING -- ------- --------------- -------- ----- BUILDING PERMIT ISSUED ------------------------------------------------------- ADDITIONAL COMMENTS ---------------------------------------------- - ----------------------------------------- --------- - -- ---- ---------------------- ----- ------- ----- - ---------- ----------------------------------------------------------------------------- t ae Final Inspection by: --- --- SAN JOAQUIN LOCAL HEALTH DISTRICT f C U 0 1_'AA RPV 5M - —... _..