76-900 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE- .............. .......... APPLICATION FOR SANITATION PERMIT Ico mplets In Triplicate) Permit NO. ........I.......... Date Issued .............................. This Permit Expires I Year From Date issued ................... Application is hereby made to the Son Joaquin Local Health District for a permit to construct and install the work herein described. This application-is made in compliance with County Ordinance 1949., § 44 and exi ng RuZond Regulations- JOB ADDRESSAOCATION ...�_/Z ......................... CENSUS TRACT �-----_------------------ Owner's Name 9 rk- <7Z- .............••---- ........................ ....................Phone J-0 ...7-2-27- - Addres ... City Address ......... .......4- ----- .......Ci ................. Contractor's Name i-, --------------- - -------- ....Llcense#4�Y" --- Phone Installation will serve: Residence 5(Apartment House 0 Commercial oTrailer Court 0 Motel 0 Other.................................. Number .................. of living units:.... .....>Number of bedrooms ...Garbage Grinder ---- Lot Size _15? Water Supply. Public System and name .....:._-_-••- ------- --------- ............ ....... .......................................Private Character of sail to a%depth of 3 feet. SandO, SiltC] - i C10Y 0 PeotO Sandy Loorno Clay Loam o Hardpan 9�_ Adobe _Fill M6terlol _.......:...1f 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 if public sewer Is available within 200 feet, PACKAGE TREATMENT SEPTIC TANK .............. ....... Depth 4, Type P.,- - ' ' Liquid De .......................... Capacity ... ..... Materlal.C..�. . No. Compartments .... :eore;. 1, '57 Distance to neare t: Well .............. ....-.::.Foundation _/ Prop. Line LEACHING LINE No. of Lines . . ..... Length �ff each lifin-------A40... ... Total Length ....... V Box .... ... Type Filter . ....t Materia ...Depth Filter Material ....../Y.............................. to Distance to nearest. Well "a-49....... .... Fou at ------- ---- "f ion Property Line .__Z. ..... Diameter SEEPAGE PIT V Depth Q r ..... Number ...................... Rock Fill I _ 11� It, 3 ed Y6s No 0 Water Table De Y.S11 . " /,j pth ..... .....................................Rock Size 1 00 Distance to nearest: Well .0.0.........................Foundation Prop. Line..........;7., REPAIR/ADDITION Prev. Sanitation Permit ` .............. ------- ............. Date ...........------------------- Septic Tank (Specify Requirements) ................_....................................................... Disposal Field (Specify 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 Son Joaquin County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local Health,District. Home owner or 111cen- zed agents signature certifies the following: "I certify that in the pe5folrrnance of the wor for which this permit is Issued, I shall not employ any person In such manner r r as to betab, t Vorkman's Comp ation laws f Signed --- A-7"al 77 ...... ------70 laws Za California."r, By .............................. 4Title .. ... ..............- -- .............. ---- -------- (if other than owned FOR DERARTMENT USE ONLY APPLICATION ACCEPTED BY. ....7�... - - ------- - --- -- -- --------- .- c---------------------- ------------------ --------------- .......... -------------- ..............DATE ............. BUILDING PERMIT ISSUED DATE 10 ADDITIONAL COMMENTS.------- --------- --------------------------- -------------11*------- --------------- ...................... --------------------_._................... ...................... ................. ....... .............I——........................ ----------- .......I--------- ................................................. ...................... .................. -- ----- ---- - - ------- ----- _.. .... EH 8 . .5..M. ....... . . ......................•----.....---••-----------------. --- ............Finot Inspection by. .... /. ..... ....................... I—-------11------_---_ --------------- ........ ate1/- ............. 13 241616v. N JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3H