74-360 - Laserfiche WebLink

Home Browse Search

r FOR OFFICE use: APPLICATION FOR SANITATIONPERMIT .....:........ . � Permit No. ... ..........I....................................I...•..... ;Complete in Triplicate) S........'...:" 7 '. .. This Permit Expires 1 Year From Date Issued Date Issued 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. 549 and existing Rules and Regulations: JOB ADDRESS/LOC ON -.46 .... ..:.. :............:.........................CENSUS TRACT .................. Owner's Name ._..._. .._... ...... .:..... ----------------- --- ---.Phone ............... Address -- ---1-.0..0.3 v .F _.. . . _-•--.... City .._.... ----------- . ..:........... . .3333-- •--n- 3333 --- - - --.... .........---. ........._....._.... Contractor's Name ...._:_._._ --------License # �i��,�.'�`::_ Phone -::3333:_.:.:..:...:.......... : Installation will serve: Residence ❑Apartment House-E) Commercial []Trailer Court Motel [] Other .... :. Number of living units:.... Number'of-bedrooms . Y__Garbage Grinder ...... Lot Size ._ O - 3 333--3333•- - Water Supply: Public System and name ..........:..............!. ------------.----------------------------------------------------------..........Private lJ Q Character of soil too-a depth of 3 feet: Sand❑ S' t❑ Clay E] Peat[:J Sandy Loam F] Clay Loam ❑ ` r . . " Hardpan Adohe ❑s. Fill Material _........... If yes,type ............................ (Plot plan, showing size of lot, location ofsystem in relation to wells, buildings, etc. must. be placed on reverse side.) j NEW INSTALLATION: (No septic tank or seepage pit permute d�ublic sewer is avoilabte within 200 feet,) 1 PACKAGE TREATMENT [;] SEPTIC TANK Size T�___! .�'�............... liquid Depth ..#............. 1►� • Capacity .� QP.. Type -- :Materiat. �:. No. Compartments ."?�.......... .. Distance, to nearest• Well _�.............. ..Foundation ...��._......_.... Prop. line ...................... I --3333-- •3333 -. LEACHING LINE [� No: of Lines _...... ----------- Length of each line-----VPA....:......_... Total Length __�.Q.................. . 'D' Box ...... ...... Type Filter Material ____..'�� . ...Depth Filter Material9 .... .................... Distance to nearest: Well ........_e&./...... Foundation- ..../.f1............... Property line _. ..00.. A �' SEEPAGE PIT [� Depth -_...__'............. Diameter ----.1,3---- Number _.__._______....__......_... Rack Filled Yes • Water. Table Depth ........ -••_%,P...........................Rock Size Distance to nearest: Well ....-...___ r � 1 a4----- Foundation ----/•R•-....... Prop..line �------------ REPAIR/ADDITION(Prev. Sanitation Permit# ------------ ----------------------_- -_. Date .............................._... I .. . SepticTank (Specify Requirements) .................•--...•---------........--------------•------•._......................------......_.._...-----•----...._............._.._ DisposalField (Specify Requirements) - ..--••--. --••--••----------------------------------••-------------------•---•-•..............--•--............ ............. j . ---------------•- --.._..._. ............................ ---------------.......................---------•----------------- ............................-................................ •-•-------••--- ---_---------------------------•--.._.._._._._ - ----------------------------------------_........_.......-----------._..._.------------------•--.._..---....------------------------- (Draw .....__...3 333-•----- - (Draw existing and required addition on reverse side) i I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquln 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 to Workm Compensation laws of California." Sigkned ., .. Owner .•. •--•.....-._ By .._.. . ... Title (If other tha -owner) FOR DEPARTMENT USE ONLY � APPLICATION ACCEPTED BY ... - . . .................. .....:............................•...... DATE -• •�. ? BUILDING PERMIT ISSUED ................................ ........................................................................DATE .......................................... . ADDITIONAL COMMENTS . = -..:_..... .. ................................. ........ .... ----- ------•--............---....... --........: ......::_.__...- ....... ............. ..................... •------- -- --- ....-. . ..:_ . .3333 •--. .. ..:3333-- ....-• -• -- Final Inspection by . . .. ............::............................I- -Date p .- SAN JOAQUIN -LOCAL HEALTH DISTRICT M :: I:- H_ 13 24 1.-AR RAv SAA Y 7177 3 M I