76-954 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ............--........_....... --..._........_.._.. Permit No. (Complete.in Triplicate) .......................................................... f. This Permit Expires F,Year From Date Issued Date Issued --......... -1 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: JOB ADDRESS/LOCATION // .. .. ......:. � 1 Owner's Name ..... c .... Phone .................... . ...t • AddressCity - - Contractor's Nam. License # .1-c ,. 3fif. -Phone .... Installation will serve: Residence Apartment House Commercial Trailer Court Motel ❑ Other Number of living units: Number Number of bedrooms - ..... Grinder ._.._.--- Lot Size .... - :------ Water Supply. Public System and name -- -----------------------------•- - ---------------------------------------- ------._...Private Q� Character of soil to a depth of 3 feet: . Sand❑ ilt❑ Clay ❑ Peat❑ .Sandy Loam ❑ Clay loam C1_ o Hardpan E6 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: [ , p [ p g p permitted if,public sew is available within 200'feet,) PACKAGE TREATMENT {No sSEFT1C TANK see a rt Size Liquid Depth ----//;X..JXS.. t Capacity Type Material.,- ---- No. ,Compartments ---6:z.---------.. Distance to nearest: Welt . .... ..._�'�'d'.�...--Foundation -2E?_�r. .. Prop. Line _�� .-.---- LEACHING LINE [1� No. of Lines .. ._ . .. Length of.each line....._.. __ Total Length .-- .... ....:. 'D' Box ._. . .... Type Filter Material Depth Filter Material t Distance to nearest: Well ....., -. Favndation ......Z0.. Property Line ...,rf .__-__d SEEPAGE PIT De th Diameter Number _ Rock Filled Yes No A Water Table Depth ------------- .................Rock Size Distance to nearest: Well .._,_._.,-__ .. __Foundation -....L.-o77—rop. Line ..�� ..._. REPAIR/ADDITION{Prey. Sanitation Permit# ........ ................................ Date .................--_--.-----------1 Septic Tank (Specify Requirements) ----------------------------------------------------------------------- Disposal ------------ ---------------------_-- •--------Disposal Field (Specify Requirements) -------------------------- ----------------- -------------------- ----------------------•- ......... -:_. ------ ............... ........................ ........... ...... - ........... ....----- . --._.._._.... ---........ .....--- --.------..._ ......... _------- I (Draw existing and required addition an reverse side) k I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin f County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local health District. Home 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 become subject to Workman's Compensation laws of California." Signed ..... ........ Owner � � Ti#fe . - �/+� '�Gc.-►�1l'!. .................................. ilf other than owner) ICOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ....�' �. s _ _ �,_. ...._..., ................ DATE '...// I BUILDING PERMIT ISSUED ............... .- - :' DATE ADDITIONAL COMMENTS -------- -• ..................... ..................:. ........ -- -:.... _. - ---------------------------------------------- - ------- •..-• ---.._........-----....----.... ........... ... ..._....._. . _.... . ................ E Final Inspection by: ...Al---_-- _ -- ------ Date'// -/. .. <:. .... SAN JOAQUIN LOCAL HEALTH DISTRICT 17/ E. H. 13 24 1-'68 Rev: .5M _ 72 33 ,�i :.