76-3 - Laserfiche WebLink

Home Browse Search

F-•---•�� FOR OFFICE USE: . APPLICATION FOR SANITATION PERMIT -7 3 .--•-•....................................•--•-...__.. Permit No. --••................ (Complete In Triplicate) ---------- .............................................. Date Issued .l:✓�.. .. ......................................................... 7 This Permit Expires 1 Year From Datelssued j 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 ith County rdlnance No. 549 and existing Rules and Regulations: Ir/ JOB ADDRESS LOCATION l-.d^... 1�... ...............................................CENSUS TRAGI ....................... Owner's Name , .......................................:...... .............Phone �`#'" . �- Address ...............................o.................. V29...6c ...... ...City ....................,_........._............ Contractor's Name ilY w a � -�--- .••..Lioense # Phone 6 w .......-•- `_ ....._. ...• --•- .................•-...._ ...•-•......... ._ Installation will serve: Residence❑Apartment House Commercial ❑Traller Court ❑ Motel ❑Other----------- ............................... Number of living units:.... ....... Number of bedrooms ... ......Garbo a Grinder _..._.. ... Lot SI .r.:................ •• - i.. ,�-t7.. ....._......Private ,❑> Water Supply: Public System and name ............................................... ... Character of soil to a depth of 3 feat: Sand❑ Silt 0 Gay ❑- Peat Sandy loam ❑ Clay Loam Hardpan❑ Adobe Fill Material ............If yes,type............... .......... :. (Plot plan, showing sire 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 feet3 l �0 0 PACKAGE TREATMENT [ ] SEPTIC TANK{ I 5€7R� ...... ......................... Liquid. Depth ..--- ................. - 7 Copaci ------ Ty e - ------- Material ...... No. Compartments .. ............ .... _ Distance to nearest: Well -----74..._-•..- ..............Foundation ...... ..... Prop. tine ......................VQ LEACHING LINE [ ] No. of Lines ........................ Length of each line.................. Total Length ............................ •D' Box ......... Type Filter Material ....................Depth Filter Material ._.._........ ..........,._.........._.....� i I Distance to nearest: Well ------------------------ Foundation ------.............-,.... Property Line ........................ SEEPAGE Pit [ ] Depth .................... Diameter ...._ .......... Number .......................-..... Rock Filled Yes ❑ No Water Table Depth .............. --- ----- ---.....-----....Rock Size ................................ W 00, Distance to nearest: Well ........................................Foundation ............:....... Prop. Lina ....,................. REPAIR/ADDITION(Prev. Sanitation Permit a................:-------- Date ..................................� GS_ L Septic Tank (Specify Requirements[ --._.. ... _�... _.�.-----�.-- --------- - Disposal Field (Specify Requirements) ----- -•---sw `�•-©-- --------•.... �•��" ---------------------------- ------------------------- ...... .. ---------- ...................... i (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:Dlstrict. Home owner or licew 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 Wor . n's Compensation s of C tifornia." Signed ------------- J!A--t- --e: r - . .. ;fit.le I By ----------------------------------------------------------- --- -----• ---------..__...------------•-------------- (if other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------ F "-- -- -- ----�................-----•••--•....._--- ....-.......... DATE ,_...�...��.--�G------------- BUILDING PERMIT ISSUED DATE _.. ADDITIONAL COMMENTS j� ala ' �` --------------------------------------------------- -- ----- . ........................... I . _._ �.- -t .-.__...-. _Y ..� ._ . ............. --------------------- -------------- -- ----------------------------------------------------------- ... ... -------- fina0 nsction ........ .................. ----------- ------..Date .... ` k-------..__..----- EH 13 24 1-68 Rev. SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3M