76-185 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ............................ 4 �'�Permit No. ..70 (Complete In Triplicate).................... .......:. Date Issued ........ ..... . This permit Expires I Year From Date issued li _ ............................................... Application is hereby made to the San ' Joaquin Local Health District forte y permit to construtt and install the work herei q described. This application is made in compliance 1 with County Ordinance No. 549 and existing Rules and'Reg� la�ionsi i JOB ADDRESS/L©CATl.O __� .0.. . '"` � .I -•._.... �.. ►• :......._ ,..._CE, RAC7 r. u..... NSUS-:T Owner's Name ......... .,: '�..�.. -� ;X4a Phone ... ...._ t ez xo Address ---- r 'Z City, Contractor's Name - :cense # . �- :1. .. Phone . . , . ��. Installation will serve: Residence%Apartment.House 0 Commercial❑Tra..iler Court ',E] Motel []Other '. Y -.--• ! k or Number of living units:__,.41-__ Number of bedrooms .-•. ••...Garbage Grinder. ` '... Lot Size -_.r ��`•+ - i } rPrivate r r ivate11Water Supply.. Public Systemand name -------- ......_. Character of soil to a depth of 3 feet: Sand b Silt Clay ❑ Peat Q. Sandy--Loam-{D_Clay Loam Q l ' ............... ......... ' II Hardpan[�' Adobe Fill Material ....._..__..if yes,type (Plot pian, showing size of lot, location of system in�relation to wells, buildings, etc. must be placed onlreverse side.4°4 NEW INSTALLATION: (No septic tonic or seepage it permitted if,public sewer is avattable-within200jeet3 1 t ; 'th . PACKAGE TREATMENT ( SEPTIC TANK[ 1 J i f. JF I�Srx ---- ...................... ............. Liquid Dep C . - No. Compartments--•----------- ----- Type -•---------- -- Material-------------- =-•--- •-•.-4-"::... -i• D stance to nearest: Well: ----I Y'-'- -Foundation ----•----- _--•-_ Prop: Li6k_ .•• .'•y LEACHING LINE [ No. of Lines ......../. Length of each line.-----o2. .F ------------ -Total Length .cs .-._Y 'D' Box .._�- Type Filfer Material ....Depth'Filter Material . --•�'• i•' ........................ .. I 3 . i Distance to nearest: Well �w.Ch foundation ... :........._. Property Line .. ............... 1i Ii , i SEEPAGE PIT Depth _.a ......_. Diameter 1..e�.�.--__-- Number ----•- �--.....---•-.•. ..iR k Filled_ ._ sc� �No Rack Si L Water Table Depth ------ , ------. •... .. . ...-- l - at -- . Line ---- - Distancetonearest: Well;-.� -(�' •••.foundtio � ------- n '-'--n-:-- ------ --on Permit ........ �--_. DateREPAIR/ADDITION(Frev. Sanitati1 il ` _ Septic Tank S ecif Requirements) - - ---•-- _ ...... ............ - Disposal Field (Specify Requirements .-. �,� .. . _._ . E c' '- l .... ........... ............. I i�. .•i !^} . rr�ri............................... ....................... . . 9. -------- - - -•-------------------- -- - .. m. Draw existing andliequired addition on reverse side[ I .hereby certify that 1 have prepared this application and that the work will be :done in accordance with San JoagiuinF County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Loc61 Health Distrltt. Home owner or licon• sed agents signature certifies the follow* .�.�, "I certify that in the performance of the work for which th!s .permit Is Issued, I sha11 not empiay;,any person In such manner, as to become subject to Workman's Compensation laws of California." Signed I --•--••....- - 1. ....---- Owner ----- aY - 7 &,' _ i (If other than owner) I FOR DEPARTMENT USE'OI�ILY APPLICATION ACCEPTED BY ._.._. ..-- __ 1 DATE ... -- 7 ___ R• ••_________________ __ ___ _________ •• __- ..,..�,.,.,�...,..�..�..._.�,,�,._.�.-_-..--•�..___.:_ .. 'w ..:`':_D TES---'= BUILDING PERMIT ISSUED ------------ -- -�—_ ADDITIONAL COMMENTS -- -- ---- --------------- -- � -- - __ - - .,._ - � � 3 -- -------------- ---- -_-------•- -- •----- -------- .. -_.::_.-• ---..._._.... -------------- ----- ---------------- . Final inspection by: ----.._.:-- •------- `/ Dae ......r ......... .......... iH 13 24 J.-68 Rev. 5M --'-' . SAN JOAQUIN LOCA - H-_ TH DIS Rll 8/7h 3M