74-900 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ...... j 3 ST APPLICATION FOR SANITATION PERMIT - . . ..!...................... .�------ (Complete P p to In Triplicate) // Permit No. _.._._-... �_ ---• This Permit Expires i Year Fran Date Issued Date Issued Application is hereby made to the San Joaquin local Health District for a permit to construct 'and i Regulations- described, This application is made in compliance with County Ordinance No. 549 and exu ti g install t Regulat onwork grein � he i JOB ADDRESS/LOCATION 1 .,q.. -�O„•- -,.-._-�{ M S-7b -k N .................. Owner's Name ............... F.lthl. 'ln ..R_r--.. o i2:�. SUS TRACT 6 ............................... ........ .......... . .. .... ......Phone ..._.. 3....- ...... Address .................. --------....._.:------- °-•-•--. --.,..-.--_. City _... Contractor's Name ...._ -> M: ..-•__.- - --------.-...License # ........................ Phone ..-------------..._... Installation will serve: Residence ❑Apartment,House❑ Commercial [-]Trailer Court ❑ Motel ❑Other ......... Number of living units::............ Number of bedrooms ..........._Garboge.Grinder ............ Lot Size .... Water Supply: Public System and name ................. 4 0 ----•-•-- ---------------.-----------------------.....---• Private Cl Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay [] Peat[D Sandy Loam ❑ Clay Loam ❑ 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 peimrdited-if public sewer is available within 200 feet,) PACKAGE TREATMENT Capacity C�.p . Type -. ,....�_2,t-D, ---- TX_. Liquid Depth ............... ' SEPTIC TANK � Yp fl.- ........... - ' "� Size, 2e Material.;.- C� No. Compartments ..._` Distance toNo. of Lines . ..nearest: Well -••-.-_.%.............Foundation... 0.... -y-.. LEACHING LINT: � � ...._.. Prop. Line ...�_.. __._._..... [ plength of ecic line ._...17 .,y-.fi Total Length _...1 C . 'D' Box ._:.! , Type Filter Material �Materiaf Distance to nearest: Well �`��Q__._- •- Foundation �d � f _ --...._. Property line .............. SEEPAGE PIT ' Depth .. ..5 ..�-- Diameter Nurr�ber .._.:; ------ ....:_ Rock Filled Yes No F = - Water Table Depth ... .... ..Rock Size'..,.. y '• Distance to nearest: Well .. - �. ® undation� _..-•----- •------- Fo REPAIR/ADDITION(Prev. Sanitation Permit# ------------ - ' ....-.-•)P rop. Line Date ------------------------------> Septic Tank (Specify Re uirem nts) ............ . ....... ...-•----- .. :._.. ................ Disposal Field (Specify Requirements) ............. .... , -•-•.............. . ---- --- . ...•-- ------------- (Drdw 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 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 beco a subject to Workman's Com ensatia laws of California.” Signed - :.. ---- Owner BY 4 ............. Title . .._ ................... . ..........................._. . (I other than owner) • ��- _ -_—.-_ -� _. --r-----_- ---.= FQ"EPART'MENj,,1JSE ONLY APPLICATION ACCEPTED BY __ ....... DATE BUILDING,PERMIT ISSUED --.._....' ................ .................: - �-�-•-•-------- ADDITIONAL COMMENTS ..P•. --__-- -- ............ ..... .......DATE ......._...-- ----------------------- ------------- �� / y . / /5....- ...... ... ....... ....................... ---------- Ina Inspection by: ......... ..Date .. SAN .i0 UIN LOCAL HEALTH DISTRICTE. { A 13 241-'68 5M