77-44 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USEs IAPPLICATION FOR-SANITATION PERMIT ,�/ , ....................................................... Permit No. .'Z7-.:Z' {Compiato In Triplicate! /: —.1....-................................ This Date Issued '- Date issued' ... Permit Expires 1 Year From a Application Is hereby evade to the San Joaquin Local Health District 'for a permit. to conshuct and Install the work herein described. This application Is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: s4JOB ADDRESS/LOCATION �,3 055" ..... �... s.cs :... .k'. ...............................CENSUS TRACT . ...... ....: Owner's Nome ........... �.......e !�!, y i/1! ...... .. ............................Phone .� '.w�. �....._.. Address ...................... ..................................................................City ----• ~'✓? 6.........---•-•• 5Z3-- ;`....... Contractor's Name l_-_.r.. ��!' /� '�✓ ' f�'rY ...................... ..License ._.__.-..... Phone : installation will serves Residence Apartment House Commercial❑Troller Court 0 Motel ©Other------------------------;•-•---.......... /: .9�y-es Number of living units:.... ..... Plumber of bedrooms .......Garbage Grinder --._.__.---- Lot Size .---:..................... . ... ......... Water Supply: Public System and name .................... ...••-.— ---- - ----_•-----•..._...........__...........---...............Private . Character of soil too depth of 3 feet: Sand o Silt❑ Clay ❑ Peat❑ Sandy Loam 9] Clay Loam❑ ; Hardpan❑ Adobe❑ tall Material ............If yes,type ............... ............ r (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse sl 0.) NEW INSTALLATIONS (No septic tank or seepage pit permitted if public sewer is available within 200 feet,l PACKAGE TREATMENT { ] SEPTIC TANK ] Size.._....s....................................... Liquid Depth .......................... w I. µ ` Capacity ..... Material...................... No. Compartments __-------------------- Foundation Distance to nearest: Well Prop. Line LEACHING LINE [ ] No. of Lines --------------•----•-•-- length of each fine............................ Total length ........................... D Sox Type Filter Material .._..:?"`:.....Depth Filter Material ...................................4....... Distance to nearest. Well Foundation .....................:_. Property Line ...................... �: Number flock Filled Yes ❑ No { ;. SEEPAGE PI3 ( ] Depth - Diameter -.... � ..Rock Size r Water Table Depth --_--_----... - ....................... " Distance to nearest: Well .......Foundation ...... Prop. Line ------•- � s t: REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ pate ................ E Septic Tank (Specify Requirements) ................�`w. .`._r�. i:.11....... !. :.. :..._.. ............... %T ' T , Disposal Field (Specify Requirements) ia� Ta �� s Ti ��' ,�� c ........... ..-. ..... `.. ................................................•--••----....----.................._-............._........... ........._..................................................................... r= ...... -......................... ............................................_..........._._..... -•........................... .. (Draw existing and required addition on reverse side) d I hereby certify that I have prepared this application and that the work will be done In accordance with San Joaquin County Ordlnaa�es, Stats"Laws,-'and Rules'and"Reglilations of'the Sats Joaquin Loco! Health"Diitriet. Huioe gwnatr or liter- sed agents signature certifies the following: "I-certify that in the performance of the work for which this permit is issued, I sholl not employ any person in such manner as to become subject to Workman:s•Compensation laws of California." Signed ......C...&&b e.! ...?.. cN........................ ............... Owner •' ..... . ....... .. Title 8y .__::.....ct� . - ...............� .... ..{If o�er�t�t�owner `— - ► FO "E TMENT USE ONLY APPLICATION ACCEPTED BY ........ , DAT ...�, :.7.._?.:......... ..:.. BUILDING PERMIT ISSUED m. .DAT ....... : : ADDITIONAL COMMENTS :.._:_....-. . ......._.._..-- ........--- ........ .................................. ..,.. ,f_..._..... - t Final Inspection by Dae . .. . .. .. .. Eli 13 2!t 1--68 Rev. 5K SAN JOAQUIN LOCAL HEALTH DISTRICT /7h 3M