74-408 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ...... ... Permit No. ......`... � d (Complete in Triplicate) - 74 ........._......................... This Permit Expires } Year From Date Issued Date Issued ,�......... Application is hereby made to the San .Joaquin Locai'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: JOB ADDRESS/LOCATION ...- - ..a _ C.._�------ t7�_-/h�Ca. CENSUS TRACT Owner's�Name� s�r�..4c�..ls..... ........................ ...�:.... . .~..._Prone .................................... Address City .... � r's NLicense # . .. Phone Installation will serve: Residence CO.Al5artment House-0 Commercial :oTrailer Court 0 Motel ❑Other ---•----•........................•-•----••-- Number of living units:.......... . Number of be ooms ... Garbo e Grinder. Lot Size ......................:. ................. . Water Supply: Public System and name -,--- ----. - -------------------------------------------------....Private Character of soil to a depth of 3 feet: Sand'[] . Silt❑ Clay eat❑ Sandy Loam 0 Cloy Loam Hardpan ❑ Adobe '[� i{/F I 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 if public sewer is available within 200 feet,I��// PACKAGE TREATMENT [ SEPTIC TANK ite.... ..................... Liquid Depth -�`- -_-_-.....- Capacity ,l �� .._._ Type :.` - Material.- !_ Compartments e.. Di nce to nearest: Well ,[r ._. Foundation ... p { •-• -• ---•-•-•--- � ( Pro . Line .. .f. G j �y r � LEACHING LINE No. of Lines ....._��- -�_..... Length o each iine.__ ..GI �.._... Total Length /../... `D, Box)-to . 'S:. Type Filter Material ... ..... ........Depth Filter Material V1 stancDinearest: Well .5 ::-_• � -FoundProperty Line .6�. ............ation _..�.----_-•- -_-__-- •--•--- SEEPAGE PIT Depth ... Diameter �. :��... Number _--._;I__ _._. Rock Filled Yes No o''t L _ Water,:Table Depth ------�- --r----------==--•--------•------._Rock Size �-�---�-•--- Distance to nearest: Well .......cl,4I ...Foundation .. Prop. Line .5..-_-------------------- REPAIR/ADDITION REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date ..................................] Septic Tank (Specify Requirements) ----------------------- ----------- -•----•---------- ..........w-_........... ......... p 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 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: "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner as to become sub o Workman's Compensation laws of California." Signed ----------------- •------- ------.. ..... ...................................... Owner f By ....................... :..-------- -- N ..................... Title .......... ............. (I€ other than owner) i� r /—QW;FARTMENT USE ONLY APPLICATION ACCEPTED BY ..... . ........ .. . .. ,. ---• -•.................................................... DATE .....,��=�f� - -r�-.......... ._... BUILDING PERMIT ISSUED ..... .. DATE ........................ . . .._..--•---••........................ ...................... ............ ------- ADDITION L COM ENT --- ----- - --- -- • ------- ---- - :........................... -/,r- �{....... �. .�. - --- ..........................................................................................•..................................... ............ .......................... = ....-•-•------•------••-•--•------------...---------------•-----------------..... ..... ............ Final Inspection by: -------------•....-•-------••---•----- ._..._.._.._.....Date .... t.. .................... SAN JOAQUIN. LOCAL HEALTH DISTRICT r- u 13 24,k n--- r.a 7177 3 K