75-273 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE, �= APPLICATION FOR SANITATION PERMIT ...................................................... (Complete to Tripilcate) Permit No. .. S .�".... .... F This Permit Expires 9 Year From Date Issued Date I:aced ._... .. -, ....S 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 rr� t An 6amplioonce with County Ordinance No. 549 and existing Rules and Regulations+ I JOB ADDRESS TION � 7�..7 . 4rA M RW_-_-.---.... Q6A D....................CENSUS TRACT ..._....:.-----•--..:..... /IOCV,jJ_... : p i=.FYl1�l i . ............. ..... ......................Phone .. �a9.-.� .� Owner's Name .... ... .._ .... ,.. .. A ......... Address ..... ....''.l AA.....t�!�?r�l A!t�(� _a.... 1 .................Cl. . i ...:4 !!.'P0.......__........... �...,.�..,j Contractor's Name ......1-99 R`.�..... ........�'1AluA6a144................:...License ------- Phone _33 installation will serve: Residence kApartment House J3 Commercial OTraller Court (3 Motel[]Other.............................•••............ Number of living units:. ........ Number of bedroom& --..?)....-Garbage Grinder .............Lot Size . .7:50, :..... " Water Supply: Public System and name -•............................__...................---......_..............................-----.......Private Character of soil to a depth of S feet: Sand© Silt Q Clay Q Peat Q Sandy Loam fl Clay Loam Hardpan Adobe❑ Fill Material .... ......If yes;type......... _: ',Plot plan, showing sure of lot, location.of system in relation to wells, buildings, etc. must be placed on reverse sills.( � NEW INSTALLATION: (No septic tank or seepage pit permitted If public sewer is available within 200 feet,! i -4); PACKAGE TREATMENT [ } SEPTIC TANK Size....................�..�. .S�..................... Liquid Depth .........v.......::..... t;Z 44 - ?t No. Compartments .. _......:. # Capacity ...••-----•,........ Type .. .1. ... Material. .. p ; Distance to nearest: Well .............................Foundation .0......... Prop. Line... TEACHING LINE +JA No. of Lines ......:��.............. Length of va ine....:4D............... Total Length ...��:�..... '.. 'D' flax �,.rra..... Type Filter Material' !S�pth Filter Material ..L �...� ...� ........ .......... Distance to nearest: Well ...J Q�. . ... Foundation . .............. Property Line ... . .......`.....J�[I SEEPAGE PIT Depth --- j ........ Diameter ..�-'3�.�...,.. Number ...��...........:......... Rock Filledd Yes (9 No �]' 1 Water Table Depth .Rock Size K:Zi s Distance to nearest: Well .......�." ......................Foundation ....................••Prop. Line ...15 REPAIR/ADDITION[Prov. Sanitation Permit# ............................................ Date ................................ .I j SepticTank [Specify Requirements) .................... ...............•• ....................................................................... ................ f Disposal Field (Specify Requirements' ....--•.......................................... ................................................................................� u .................................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 District. Home owner or licew sed agents signature certifies the following: "I certify that in the perfarn once of the work for which this permit is issues!, I shall not employ any person In such manner. as to become subject to Workman's Compensation laws of California" Signed ............................. ..............--- Owner �Yi �.✓. ....- l�Y' .. ................. Title 'I4T4'/..................................... i i . at er than owner) t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ..------•-- ................•.. DATE .....✓ ,"T ...::: BUILDING PERMIT ISSUED ...... . ......:. :..:..'..:..:. ._:..:....... _T ATE=... ., ............................... .._........._......:..... - ....._ .....:_.__...... _ ADDITIONAL COMMENTS ... ................ ....... ..I.......... ............................. ..---•-•------............................... .... ........ . ...... -----...._ Final Inspection by: Date . . ... _ ..T.lx............ EB 13 2h 1-68 11ov. caM SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M