78-356 - Laserfiche WebLink

Home Browse Search

FOR OFFIC15 USE.- APPLICATION FOR SANITATION-PERMIT ------------- ------------ Permit No. .......... ........ lComplete in Triplicate) T Date Issued 71 his Permit Expires I Your from Date Issued ........ Applicati6n 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"comp lance with County Ordinance No' 549 and existing Rules and Regulations.- J013 ADDRESS/LOCATION ............ ..... . ........... _47�.Y......0................CENSUS TRACT .......................... Owner's Name .. .... -------14-......._ .....................................................Phone ....................._......... Address --------I--------- ............... City ....................... ................ Contractor's Name ------------A-/V------ -ei�---------_----- ...............__.......License # .. Phone Installation will serve: Residence[ApartmentHouse 0 Comfnerclal'oTraller Court 0 Motel E]Other ..............___.................. Number of living units-----/..... Number of bedrooms __._____Garbage Grinder (q—'.. Lot Size .19615-*.�_ ...................... Water Supply: Public System and name .... ...............................................------- ........................................Private Character of soil to a depth of 3 feet: Sand L] Silt 0 Clay 0 Peat 0 Sandy Loam 0 Clay Loam 0 Hardpan 0 Adobe Wil 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 .. ...... Liquid Depth .......... .11 ;��V Capaqty -r . .... --- TYpe � o. Compartments ........ Distance.to nearest: Well ......S_b_...............Foundation ---/t�............ Prop. Line �./............. LEACHING LINE No, of Lines .,3_______ _________ Length of each line--- Total Len th ............ 'D' Box 4r-(. Type Filter Material A-047�.....Depth Filter Material 7................................. Distance to nearest: Well ---5_0-------------- Foundation 6- ------ ........ Property Line ........................ SEEPAGE PIT 'Jq--_--Depth c>I--------------- Diameter ... Number -_5-------1............ Rock Filled Yes rt/ No 0 Water Table Depth ------- ------------------- ...Rock Size ... ....... Distance to nearest. Well ...... ------------------Foundation Prop. Line .......... R EPAIR/ADDITION(Prev. Sanitation Permit# ---------- -------- .................... Date .................. SepticTank (Specify Requirements) ............_.................................................................... -•-------...._..................._....._.....---........._ :Disposal Field (Specify Requirements) -------------------------------------- ...... -------------------------------- -------------------------------------------- ------------------------------- -------------I--------------------------------I------ ----------------I-----------_-------------11-1.."........ ................I....................... ------------------- ------------- --------------------------------- ----------------------------•-•----------------• ...................................... ............ ....................... �11 (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 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 Compensation laws of California." Signed ....... ----------------- --- ---- - Owner By ----- --- - ------ (if ----------------- ------ other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED By ------ - ---------- - --- --- -------- - '2& BUILDING PERMIT ISSUED ------------------- ---------------I---------------------- DATE ....... ........... -------------------- ........ ----------- ......................DATE .............. ............... ."I ................. ADDITIONAL COMMENTS ............................................ -- - --------------- -- ------ ------------- .....-----------__-------- .................. ----------- ----------- -------- ------- --------------- • ---- --- . ___4_.._..._-__ .. ...... .. ----------------------------------------I------------------- ...... ... ...... .... ----- ---- ..... --- -----------........ ---------- Final Inspection by: --------- ------- ---------------------------- ------------------ . .2�- .. .-Date -------- -------- P-1 - ----------------- EH 13 24 1-68 11ev. 5M S N JOAQUIN LOCAL/HEALTH DISTRICT, 8/74 3M