75-1019 - Laserfiche WebLink

Home Browse Search

•'�- 4v_ OFFICE USE: d p. APPLICATION FOR SANITATION PERMIT 7 d/ C C7 Permit nla. (Complete In Triplicate) .. /- . ......................................................... - Date Issued ../ This Permit Expires 1 Year From Date Issued Application is hereby made to the Sart 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: 638 So. -Carol]. St. Job ADDRESS/LOCATION ..CENSUS TRACT ................... Owner's Name ..------•----••-------- ------hea-Lie-K€inter...... .................................. Phone .....463A]-3 0..........--- Address -----------------------------•-•-----• 1 ._ ._Carol1..St........ ..............city .....Stock#.ori....................•................................. fContractor's Name Via_A�__Pa'lex' ,g3].&_.$Ql�,i3s-- ]4 r............................license # ....-----............... Phone .b66,*9607........... Installation will serve: Residence W Apartment House 0 Commercial❑Trailer Court ❑ Motel Other..---•--•--•............................... Number of living units:__.._.,.... Number of bedrooms .......---Garbage Grinder ............ Lot Size ---'t52.g.. _.2 .1t.................... Water Supply:'Public System and-nameIr. orn a W`ter Svc ......•Private [Q Character of soil to a depth of 3 feet: Sand❑ Silt a Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam IM: Hardpan❑ Adobe f fill Moterlot ............If yes,type............... ............ f (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) E NEW INSTALLATION: (No septic tank or seepage pit permitted If public sewer Is available within 200 feet,) f PACKAGE TREATMENT [ ] SEPTIC TANK) ] Size-1—-----------------------------—------------ Liquid. Depth .................... 5-10 I Capacity ------ ------------- Tyles ----------- Material...................... No. Compartments .....................00 Distance to nearest: Well ....................................Foundation ..._......._.__.....__ Prop. Line ------....:........... i LA, LEACHING LINE [ No. of lines ---------------------- Length of each line............................. Total Length ............................. 'D' Box Type,Filter Material .........:..........Depth .Filter Material ........................................... Distance to nearest: Well ------------------------ Foundation ..........I............. Property Line ........................,f SEEPAGE PIT. [ ) Depth - ----------------- Diameter Number ............................ Rock Filled Yes ❑ No 02 Water Table Depth ......................................Rock Size Distance to nearest: Well ...................................... Foundation .................... Prop. Line ......................f n REPAIR/ADDITION(Prev.-Sanitation Permit# ....... Date ..........1}-53.--.1........) Septic Tank (Specify Requirements' -----._..E�3.st :.:..... Disposal Field (Specify Requirements) ----:-- RP si ?`Y-J??`a-mage--s------- Q ftt, 3.eaching drain . .. (1) 33a g25t Seepage Pit ---------------------------------- --------------------------•- -•---• -----------------------,----------- •-••-•....--•• ...._ (Draw existing-and required addition on reverse side) I hereby certify that 1 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 licen- sed agents signature certifies the following: "I certify that in tho performance of the work for which this permit is issued, I shall not employ any person In such manner as to become subject to Workman's Compensation laws of California." k Signed ------ D-.-:,ie._PaY' dh &.,SQ _s Itis ........................ By ----.._... --------------•-•-•-----------------•- ---*----•-------------- Title -------•-Est tQz`...._..... -----------------._- (!f other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _... -- '`- -------•-• ------------------------- DATE ...•-- ... ""- .. BUILDING PERMIT ISSUED _ Y ----------- ---------------- --------------------,-------------------------DATE ............................................ ADDITIONAL COMMENTS --- - - -- ---- - ------- = �` - •- - -•-- --== - -------�:__..-..--��-----•-- Vis`=•--- �•' ---.- - - -- .�.� .-----...........------------------- ------ - -----_--.----•-- -------------------------- ---- ---�..-•---------- --------------------_.._. .--.... ---..... ...... - • --------------- --------------- Final Inspection by: . .........................Date ----....._. .. . _:. ✓_-__.'-.__ r EH 13 2 x--68 v. SM SAI,) JOAQUIN LOCAL HEALTH TRICT 8/74 3M