74-172 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: `APPLICATION FOR SANITATION PERMIT '6 .......... 2.r... 3..... Permit No. .. :�. . ............... ?'...�i.. (Complete in Triplicate) ............. ........... ...................................................... .. This Permit Expires 1 Year From Date issued Date Issued Application is hereby made to the San JoaquIAcral-Heralth District for -a permit to construct and install the work herein 'described. This application is made•in compliance�with�County Ekdinon�e'No'�5a9 and.'existirib!Rules and Regulations: JOB ADDRESS LOCATION S. ��_�.._,�_.__�°�,�i. ..�� _ .....cENsus TRACT .... ...... Owner's Name / J ... ( e.,a,&.%o- . .--..... .�. ..... .,....?.. .. ............_...._Phone .................................... ;. �.:........ ..../�' .. _•.�lr/.�.-----------•-•----------------..Li ense ��...•- P)tone...............•------ �=.i�.(c.�.l�...° Contractor's Name . ..... ,a jl _.._�(�� # � . .. -Installation will serve: Reside ceA Apartment House❑ Commercial❑Trailer Court 0 i Motel E]Other Number of living units:........ Number of bedrooms J.......Garbage Grinder,46;.'6T Lot Size 'Lfs!"::— 1 a e Water Supply: Public System and name.............. . Character of soil to a depth of 3 feet. `YS�and❑ Silt 0 Clay ❑ Peat❑ Sandy loam ❑ Cloy Loam is F Haroan ❑ 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 INSTALLATIONi (No septic tanklior seepage pit permittee f'public sewer is available within 200 feet,) " F , PACKAGE TREATMENT [ ] SEPTIC TANK'[ ] Size........: ......I............................. Liquid Depth .........................: .. p ty ' . E Ca acs :--- ............... Type -----------•---•-... Mat ridh--,- ---. Na. Compartments ..........� Distance to nearest: Well Foundation ...................... Pro tine 00 LEACHING LINT: No. of Li r r [ ') nes ..- ---------•----•__-- Length of each line... ................. Total Length ....._..................... � 'D' Box -------- Type Filter Material ....................Depth Filter Material ---......_........_....._...__......_....... '� t Distance t o nearest: Well ..............:......... f=oundation ....._..__.._*...__.... Property Line SEEPAGE PIT [ l Depth ._._'......_. ._: Diameter ................ Number Rock Filled Yes ❑ No ❑ , • Water Table Depth ............._ _......................•---------Rock Size --------•------------•......... ^. Distance too nearest_Well...........................................Foundation .................... Prop. Line ...........-.......... REPAIRJADDITION(Prev. Sanitation Permit# ........ ►-- ------------=------ Date ............... .--.__..--------_..) Septic Tanis (Specify Requirements.- .............. ........ ..........................- -----....... ....-_...., f Disposal Field l5 ec ` /n----- ------•----- ifY Re uirements) .S' e •-••-•................. I , ._.._.........>-...............................-.......----------------•--..__..._. -------_........ ...........N (Draw existingond required addition on reverse'-side( I hereby certify that I have �repared this application and that the work wll=sb done in accordance with Sart Joaquin County Ordinances, State Laws, and Rules and Regulations ofrthe San Acquin-local Health District. Home owner or lican. sed agents signature certifies-the following: "I certify that in the performance of the work for which this permit is jss ed, I shalltn6t employ any person in such manner I . p .. ............. . 4v►wner g - 'Is Compensation laws of California: r E Signed _.. ...... I1. E as to become subject to Workman s .. t 'r BY ..,`Title .................... ----- ). ► �� +., (If er than owner).. t YIN jV � -! '). FOR DEP,'RT4ENT USE FONI,Yf } BUILDINGACCEPTED BY.. ::.".. .. .... !. _. DATE .• ... . . PERMIT-ISSUED ... - ------ . f..... ....DATE . .. S ADDITIONAL COM E f r . .. ... --------- ....................................... EYE-...... ..........t. ....... r Final Inspection by: • �. .................. •..............................-...... .....Date . ,7:„l�!:�7 ............ .�SA .1OAQUIN LOCAL'-HEALTH DISTRICT. is -E, H,1.3 241.'68R 7/72