76-962 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT :................ ---------.............................. Permit No. IComplete in Triplicate) This Perrpit 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. 549 and existing Rules and Regulations: JOB ADDRESS/LOCA ON .__ t?it ' /.................. � ._.._.. .._._. .....CIENSUS TRACT Owner's Name .............................. . --........ ._..��Qa�..........�� f.C.�.._, Address .._..... 1................. . � ...... ....... City ... .Q.? .............._.................... is Contractor's Name .......... :.__y.A..........................Lloense # Phone ��.� . Installation will serve: Residence 0 Apartment House Commercial#Trailer Court 0 Motel ❑Other............................................ /v'��fl�X ®X 5199 Number of living units............. Number of bedrooms ---.........Garbage Grinder ........ Lot Size Water Supply: Public System and name ......... ••---••---•...............--------...._.__...------.._.._...........................................Private f� Character of soil to a depth of 3 feet: Sand 0. Silt 0 Clay (g Peat❑ Sandy loam 0 Clay loam Hardpan❑ Adobe Q Fill Material ............ If yes,type............... ............ (Plot pian, 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 i ] Size..Aoo...?.A/..1#A!............. Liquid Depth ............................ Capacity .-/Lao------ Type .i A;;tz Material....................... No. Compartments -,�?................. Distance.to nearest: Well ...AW.....................Foundation;....JS.-_._...... Prop. Line ..J.�� ........... 00 l LEACHING LINE No. of Lines ..___.. Lent �......... Total length .__.__!_� .�........ y I l -•---•---- - Length of each line------ � ©' Boxr:..---�-.:_ Type Filter Material .I�.t ;A7,eDepth .Filter Material .. f--------- .......................... rn� t Distance to nearest: Well ........... Foundation .3.40............... Property Lineal. .............. , SEEPAGE PIT ( ] Depth ,. ....._.... Diameter .:..... Number ---._._f _-....�...�� Rock Filled Yes ".. No (] Water Table Depth -- ------= ---Rock Size . f_ .....-.._.. l Distance to nearest: Well ��_....... .Foundation .120........ Prop Line . -............ REPAIR/ADDIT1614 Prev. Sanitation Permit Date ) l Septic Tank (Specify Requirements). J------- ---------___............................ ...............................................,... .-........................... Il Disposal Field (Specify- Requirementsi -------------------- . ...------•-•----•----._. -------------- ----------------------- - ...._..................---.............--•------...---......._-.-•-•----.-------......... (Draw existing and required addition on reverse side) 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, State Lags, and Rules and Regulations of the San Joaquin Local Health:District. Herne owner or licen- sed agents signature certifies the following: "I certify that in the performance of the world for which this permit is issued, I shall not employ any person in such manner as .to become subiect.to Workman's Compensation laws of California." Signed Owner r BY l .__...._ ---- --------- ..... --- title e4'� _.._..------ (If other than ownerl FORD ARTMENT USE ONLY APPLICATION ACCEPTED BY ------ ....... ........................•-- •----------- ------------------ DATE .._/. -/._��_. ...�_.. BUILDING PERMIT ISSUED ...................... . ............. •. ___..._... _ ..__.DATE ...... -_...---------•.................... ADDITIONAL COMMENTS ------------------------------------------••-------••-•---------•---- ------------------ '... - ------------------------------------- ---•-- •------ ---. -------------- ------------------------ ..---------------------- ------ ----- • -- ------------ ---------------•-----•----._-----•---•-•----------- --------------------- 1 final Inspection by: ...-------_•r�- -- ---------------- - -----••--•-•-- -•-•---- ----------------------------------------Date ..._. f.�. ._ J._...._.._ IEH 13 2 1'6 Rev. SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7& 3M