76-436 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE; APPLICATION FOR SANITATION N PR RI ........... M .,ICoPermit No. _ This Permit Expires 1 Year From Date I Date Issued .....: 5!__7 s~ .............• -••••-• :sued --------- Application is hereby made to the San Joaquin Local Health`Disteiet"for opermit"'to-construct abd-It atcill'Tthe work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: k JOB ADDRESS/LOCATION. �V7 !-- ,eP........ .............:.CENSUS TRACT .... 7......................... Owner's Name ..... _/ � �'�'/ .• ..................;......................... ....... ....... Address . ... ........... ............ City f� _..... ' Contractor's Name _..- ' ------ /:rl �._ , License# ./- Phone . _ Installation will serve: Residence,?�Apartment House- ] Commercial❑Trailer Court JJ Mote! ❑Other----•------------•............. ._...... Number of living units.../_._.__ Number of bedrooms `�; ::GofiSage C,rinder ..UD::- Wt Size 0_;.l ................ Water Supply: Public System and name ...............................................................---...........__.......----._.................--------..............,....Private-� Character of soil to a depth of 3 feet: Sand_tySiltD Clay PeatO Sandy Loam flCla Loam ❑ Hardpan 0 Adobe❑ Fi1i Material .........».-If yes,type.-'�•.......... ............ ! I V l (Plot plan, showing size of lot, location of system In;relation"-#o wells, buildings, etc. must`be placed on reverse slde`� NEW INSTALLATION: t i (No septic lank or seepage p#t'permitted if public sewer is available within 2Q4 feet,]' PACKAGE TREATMENT ( SEPTIC TANK TANK Size._.__.._. ..=! ... Liquid Depth . ................. ....:......... ..... I Capacity Type .... o. 'Compartments ..................... Distance.to nearest: Well ..... :...Foundation.. :....::..:. ...... Prop. Line . LEACHING LINEN . Length of each line ................... .Total Length ._......................_... [ ) o. of Lines -----•--•--•----- � 'D' Bax Type Filter Material Depth--Filter,Material } _ .----••......•------------------- Distance to nearest: Wel! Foundation- = :^._: ..:-_j. Property L .......'•............... Ire ...........-........---• SEEPAGE PIT ` w "" Rock Filled Yes ❑ No[ ) Depth .__._.... ---------- Diameter ...........:..... Number __.......------..._... Water Table Depth ........Rock Size Distance to nearest: Well ........................ ............Foundation ....................... Prop. Line c REPAIR/ADDITION Prev. Sanitation. Permit# ._ Date ..................... r N Septic Tank (Specify Requirements) ..... ..................... ......................................... ...:........................-. ---------- - Disposal Field (Specify Requirements) ....... ..... f .---•........-......... ---•--._...-•---------------•. ------ --•- -- ---- - _....... (Draw existing and required addition on.reverse side) I hereby certify'thot t have prepared this application Ind that the work will be don' An accordance_ with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the Son 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, I shall not employ any person in such manner as to become subject to Workman's Compensatio lawn of California." ' Signed -. -••------ Owner ?.r -------------------------------------- ---- --....-•----• Title _...11 : � i�/�/,`%C f G�(if other than o d .-"_...F DEPARTMENT USE ONLY APPLICATION ACCEPTED BY..------ -- - --------- ------ DATE - 5' G BUILDING PERMIT ISSUED _..---__ ___ ---•- _ . ADD#TIC>NAL OMMENis ----- '� nfD�.:.",cam,.: . - -------ea � .. ._ --- ..------------------------------__....... --- -- ---- ------ - ---------------------- ----- Final Inspection by: .. -- ----- - ©ate ......_. . .J_ . .- IM 13 2L 1-613 liev. 5M SA_N-JOAQLI LOCAL HEALTH DISTRICT 5/7h 3N1 5 s•►