74-921 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE- �,WFPLICATION F 3 OR SANITATION PERMIT Permit No. JComptTriplicate7 `�a ._..--•-•--••----........................... ete In l ------------------- This Permit Expires i Year from Date Issued ©ate lssuedl�: I 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 549 and existing Rules and Regulations, JOB ADDRESS/LOCAT ON ... G� //r/ It} r •.. ..-- �..CENSi15 TRACT ------••-•................ O ....................- ................Phone -- Owner's Name �¢i41.-. acJtXl S--------- Address -.._. �? ..... z4,4�- �'••• -----------•------------- City - ut a . G_ .. ............ Contractor's Name #aZS -1-_7. _ _ .. ..ram ._. ��W„...............license Phone Installation will serve: ResidenceApartment House 0 Commercial OTroller Court 0 � 7 Motel Other ---------------------------------•---------- Number of living units:___. __. . Number of bedrooms ._____------Garbage GrinderLot Size . ��5- Water Supply: Public System and name ______________ _____________ .------_.•--- _....Private Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loom n Hardpan [] Adobe;;� Fill Material ..:......_.. If yes,type -•------•...... ............ (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 200 feet,) N PACKAGE TREATMENT [ ] SEPTIC TANK I ] Size........... - -------------- _ Liquid Depth ... - ----------- Capacity -- Qd--__-. Type ......... No. Compartments ;?�........... P � cfi Distance to nearest: We11 ____��13__`.--••----------------Foundation ----1/_Q__.___..____ Prop. Lines.._------------ LEACHING LINE [ I No. of Lines ----2--------------- Length of each tine.__. _... Total length ..../2.4•x.......... .r 'D' Box 4�W..... Type Filter Mat eriat Depth Filter Material ..... ...----••...... .......... Distance to nearest: Well _:0.7............ Foundation ----.11-..r........... Property Line .............. SEEPAGE PIT [ J Depth ...,�-___.... Diameter . `�... Number _____-___- ................. Rock Filled Yes No I]' c Water Table Depth ------ ------------------------------Rock Size .... -•�<�'2 Distance to nearest: Well __-6po------.....................Foundation -- 0_.___...... Prop. Line ...... REPAIR/ADDITION(Prev. Sanitation Permit# ------------------------------------•------- Date .............................._1 Septic Tank (Specify Requirements) ........... ...•----..__..._.__._........-•---•----•---•-••---.................._ ..................._...:.................. ...... DisposalField (Specify Requirements) -----•.............•-----------------------•----- ------------------------------------ --------...........------ .................. -------------------------------- -------------------------------------------------------- ---• ----- ..............................•..................... _---------------------- -•-- (Draw existing and required addition on reverse side) 1 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 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 becom s ject to Wo kMan's Co ensation laws of California." Signed ....... -• •- .. ......... ••---- Owner ---- 7itte . --------------------------- (if other than w 0-412 FOR AEPARTMENP USE ONLY APPLICATION ACCEPTED BY ------ DATE ../4---/�-�. .....----- BUILDING PERMIT ISSUED ----------------------- ---•------------------------ ----- _DATE . .---......---._..-_...---.. ...... ADDITIONAL COMMENTS . : ... ........ .. ------------------ ----------------- -- -. ............. .. ..... ----•---------------- ................................. _ ------------------- ----------f--A�` ------ - - • �j Final Inspection by: ----•f -- - -- ------------• .................. Date l ...-..-r! Eli 13 2!, 1-68 Rev. 5M SAM JO QUIN LOCAL HEALTH DISTRICT 8/7b 314