76-995 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 1Comptefe in Triplicate) Permit No. This Permit Expires t Year From Dale Issued Date Issued .1Z-9 .-.76 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. 544 and existing Rules and Regulations.- JOB egulations:JOB ADDRESS/LOCATION .ch.........5'fo��foh ....... ..................CENSUS TRACT .........,................ Owner's Name ...�O!' /V;A..G.:_. '7.ctr-1^'� .1.................. ...................................................Phone ....y._... . 77s,.--.........6 F ..._..- Address ........ Ciry ... .... Contractor's Name ----fr•!r- i...t__.SQ,1?_s.................. ...License ... Phone .' ..qE o.7...... Installation will serve: Residence)'Apartment HouseC] Commercial{]Trailer Court 0 Motel Other ............................ ❑ ................ mercer' Number of living units:._.A__._.. Number of bedrooms -.3--------Garbage Grinder ............ Lot Size ... ��0................. Water Supply: Public System and name V✓ / ..........................................................................................Private [ Character of soil to a depth of 3 feet: Sand❑ Silt❑ Gay 92"*Peat❑ Sandy Loam 0 Clay Loam ❑ Hardpan❑ 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: (No septic tank or seepage pit permitted If public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK[ ] Size................................................ Liquid Depth ---------................. Capacity -------•-•---------- Type -------------------- Material.-------------_.-- No. Compartments ........ Distance to nearest: Well ....................................Foundation ...................... Prop. Line ......................V1 LEACHING LINE No. of Lines ...................... Length of each line......................... Total Length _J 'D' Box .... Type Filter Material ....................Depth Filter Material ........................................... Distance to nearest, Well ........................ Foundation ................-------- Property Line ......................A_ SEEPAGE PIT { ) Depth -------------------- Diameter ................ Number ------...................... Rock Filled Yes ❑ No 00 Water Table Depth ................................................Rock Size •---------. .................... Distance to nearest: Well ........................................foundation .................... Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date --................................. l SepticTank {Specify Requirementsl ...............................•......................................................... ................................................. Disposal Field (Specify Requirements) ..4.dd_.__f_;P.....Frxy '_f qy------ r . •� ,, ------.......e2-X_.. 4....X.. z................. Ss� rri ----J--------- �..._...Dt _tr_ .6.h. _�P_h. :�f......__--------------------•---............................. ..................................... -----------• -------------------•-------------------•--••------------•-- •--------•--••----- ......-......................-...................................................... ..............{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 lar'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 f than owner) BY - .." -- ----------- -- ------............---------------•------------• Title .........-..............------------- other REPARTMENT USE ONLY APPLICATION ACCEPTED BY ------ -y ••-•--•-• --- ...- ------. DATE . ....././ .x.7`..7.6------- -------- BUILDING PERMIT ISSUED " DATE ........................ ADDITIONAL COMMENTS � - -- ------------------------- ..........•................................... ---•------ -------- ---------------.....-.---------------- -- ----- --- -------- -•----------_-..._---- ---•--.... Final Inspection by- ----------------- .. ------ ."- /'I...!'•`._......................................................Date ......71 _°�..-. __.... -"... ---- ----- • 13 2a 1-68 fav• SAN J AQUIN LOCAL HEALTH DISTRICT 8/7b 3M