74-1084 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE. APPLICATION FOR SAAITATI °- ON i'ERhAiT (Complete in Triplicates Permit No. .. This Permit Expires 1 Year From Date Issued Date Issued . _-3. 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: i _ JOB ADDRESS/LOCATION , p�.�/ j _I� /Z' �-••- /• � - ,q ' ��1 CENSUS TRACT .. Owner's Name ...... ' e�-. ..1. '/Uf ---- 1i�'~ h Address .....7?d'....../ . one .--- ••- --� -• � - .................r:_::_......._ ...._. Cit CCa wGU�--� Contractor's Name e.._._ ��---- ' Ar..�C.r.�,t0- h�. ------------------------------------License # phone ..P_321 _. Installation will serve: Fr Residence ❑Apartment House 0 Commercial ❑Trailer Court 0 {4 Motel [I Other .......... Number of living units.......__ Number of bedrooms ............Garbage Grinder -------- Lot Size ...- Water Supply: Public System and name�.1..._.___.. Private .---------- ........................ Character of soil to a depth of 3 feet. Sand❑ Silt❑ Clay 0 Peat❑ Sandy Loam P9 Clay Loam ❑ ILA Hardpan ❑ Adobe ❑ Fill Material __..... ... If yes, type .................... . ' (Plot plan, shave ng�siie of�iot,>�ocafion 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 204 feet,) PACKAGE TREATMENT I I SEPTIC,-TANK Liquid Depth Capacity'I.... ...... _ Type ........._-_ _ _ Material.-----'... ... ....... No. Compartments ................. Distance to-,nearest. Well _.r...... ............._._....Foundation ...............-.-.... Prop. Line ........ ...... LEACHING LINE' �[-j --No. of-Lines r_ Length of each line......... ................1. Total length ............................ 'D' Box ...... Type Filter Material ------------- --_-Depth Filter Material ....... . Distance to nearest: Well ........................ Foundation Property Line ......_.._.-._ --..---•- SEEPAGE PIT [ 1 Depth .. . Diameter ._.. .'.. Rock Filled Yes Cl' No .�_ ...... Number .................... � Water Table Depth -------- -----------------------------•--- ---Rock Size ..........^_._...------•....... r Distance to nearest: Well ..... -------------------------Foundation _-...-.............. Prop. Line ...................... REPAIR/ADDITION(Prev.,.Sanitation Permit# -------- ------._.. --------------------.- Date ---------------------------------- Septic ------------------- --Septic Tank (Specify Requirements) -'- '- --------.-- ------------------------------ _ Disposal Field (Specify Requirementsl ._.._.--- ' -- ----' ...--'- . - .... ....... (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work wilt 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 for which this permit is issued, I shall not employ any person in such manner as to become subject torkma ' Cam enation laws of California." ,- Signed . - ...... ......... ------- Owner By ...: . .. ................................ ............................. ...... .....----...-- ...... Title .......... (If other than owner) FOR DEPARTMENT USE ONLY ----- =---- APPLICATION ACCEPTED BY .. DATE .__AAroqs-. ..�.......... ._ - --........ . BUILDING PERMIT-ISS _--._z. ,....�.M.tr.w_.-._.... _._._ ..._._.----• _ .-DATE ._ -':_•:_,..,....:._. ADDITIONAL COMMENTS -..-,- ............................. — _ ................... . •---- -----•- ---- •--'•- ............... :.: .. ........................ ...._._ .._. Final Inspection by: .. ..__. _. "------ --- Date ........ �. SAN JOAQUIN LOCAL HEALTH DISTRICT e ' C W 13 24 ,_•« 0_.. &&A