76-269 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE- .5.-7.q SE: APPLICATION FOR SANITATION PERMIT 10'.3per No. . — m . (Complete In Triplicate) _ Date Issued .-------•- 1-1 This Permit Expires 1 Year From Date Issued 1 Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This opplic tion is madelin compliance with County Ordinance No. 549 and existing Rules and R latlons: 4 JOB ADDRESS/Loc TION l,X ?!Y. / �r r� �/�7.. .1.� a s c-- CENSUS TRACT .... ................... Owner's Name ............. .................... ......... Phone ., .. . - CIO Address . .r�. _.._ .... � Z1ty� f / .. .-. ........ Contractor's Name ---------•------•..................:........License i`(39?.... Phone ..� ---- Installation will serve: Residence Apartment House Commercial❑Trailer Court 0 Motel []Other.... Number of living units_____________ Number of bedrooms ............Garbage Grinder ..__.. ..... Lot Size � ��'��-----•-- I - Water Supply: Public System and name ......._...•......................._......._..............-__..........................-...---.........._.._...Private.W. Character of soil to o depth of 3 feet Sande Silt❑ Clay ❑ Peat❑ Sandy Loam 0 Clay Loam o Hardpan Adobe O F1N Material ............ If yes,type............... ............ ' 4 (Plot plan, 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 204 feet,) ; PACKAGE TREATMENT [ I SEPTIC TANK{ I Size.......................................... ... Liquid Depth -............._............ C\ Capacity ... Type M erial------ __.... No. Compartments ni .•: Distance.to nearest: Well •--- ..... -- •--•-•.•.•--- odor ................. Prop. Line ..............._._ . F ion LEACHING't'INI_:. ' [ J No. of Lines ........................ Length each lin ........................._.. Total Length ......__.... ............... s. 'D' Box ............. Type Filter Mated --------------- ----Depth Filter Material ________............._..._................. Distance to"nearest: Well --.--•..... ....:....... Fo dation ---.-----------------_-- Property Line ........-----•-•--...- SEEPAGE PIT ( } Depth '.= ------_-_--- Diameter ................ umber Rock Filled Yes ❑ No �] c Water Table Depth Rock Size Distance to nearest: Well ----- --------------- ------- .....---------._.......--•--•-•- ----- --F............. ........::......Foundation ........------------ Prop. Line .---....---......_._.. figPAIR/ADDITION{Preva Sanitation,Permit# ...:........................ .............. Date ...:-._....:.................__---1 ;.t. Septic Tank [Specify Requirements) ...:...........:: ................. .......---..................._._. ... _...�� Disposal Field (Specify Requirements) -,llY..-_ .l '� -•_.0 --..... ..�P ,_ !��. rz ....- ........ -----• .......... •---•------ .... ............... Y 9 {Draw existingand required adds I herebycertify that 1 have re acid this application and that the ion on;rall be side! Y p P RP work�.wiil be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of.the San Joaquin Local Health,District. Horne owner or licen- 4 sed.agents signature certifies the following: ;h 4'1 certify !hat in the performance of the worts for'which this peirnit is Issued, .!.shall not employ any person in:such manner i as to become s b}ect to Workman's Compensation laws of Cal�forma." Signed " " ' ------ } " Owner i g l....7. :.._.. ............ ... BY ....... -- =-------•--------------- ------------•---.._ ...... T #e (If aMSer than owner} f FOP, DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.-------- - ------.._. DATE ..3- .3- - :.. t BUILDING PERMIT ISSUED ------------------............ -------------- -- '----- •--- ..........:DATE ----------------- ................ I ADDITIONAL COMMENTS ..------------ ----- ;L---------- --- " . ----------- ----------------------- ----------------- ---------- ----------- ------- ------------------- •-----. .... --- ._. ._ _ -- � ....�_ --: --------- --•-------•................................. � ._...-••_._. Finol Inspection by. •---e--•---•--•. _. . _. .. - -- --•- .... ...... ..............•.................-...... •- ------ _.. ----... . ....... ----- f EH 13 24 1-68 Rev. 5M SAN JOAQU€N CAL HEAVt4 DISTRICT 8/7h 3M