76-783 - Laserfiche WebLink

Home Browse Search

srwR OFFICE USES / , APPLICATION FOR SANITATION PERMIT �l...................P Permit No.,76......7 fff (Complete In Triplicate) �} ..... ................. ... ........................ . This Permit Explres t Year From Date Issued Date Issued .. } Application is hereby made to the San Joaquin Local Health District for a permit to construd and install the work herein described. This application Is made In compliance Co�ntu, ance No. 549 and existing Rules-and Regulations: III JOB ADDRESS/LOCATION ........:Z1.6.. . �. .+ .-. .. .CENSUS TRACT .......................... Owner's Name .. ... ! ,A ..: �........................ ... .................. .. -Phone .................................... Address �.. .............................City ........................................... 011 Contractor's Name ,Gt..� ��.. RltEti.�,.License .1"f '.. Phone • .. Installation will serve: Residence�VApartrnent House 1] Commercial[]Trailer Court ❑ Motel❑Other............................................ r Number of living units:... Number of besirooms 2,.....Garbage Grinder Lot Size ............ Water Supply: Public System and name ....Private ❑ ti Character of soil to a depth of 3 feet: Sand T] Silt❑ Clay ❑ Peat❑ Sandy loam 0 day Loam El W Hardpan❑ Adobex 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 INSTALLATIONr (No septic tank or seepage p€t perms If .publle sewer is available within 200 feet,) PACKAGE TREATMENT ( ] SEPTIC TANK f ] 14'�`3#e................................................ Liquid Depth .......................... Capacity pa ty .................... Type .................... Material...................... No. Compartments ...............»..... Distance to nearest: Well Foundation ..... Prop. Line ..................... LEACHING LINE No. of Lines ....../............. Length of ach Ilne....: .......:_..... Total Length .s�.... ....••----•...... 'D' Box ._ Type Filter Material . ..•. -... ......Depth Filter Material . .�.�......f...................... • Distance to nearest: Well , ... . Foundation ...14 ........ Property lite ................ SEEPAGE PIT Depth a-25 ...... Diameter e� f Number -------/.............. Rock Filled Yes [ No Water Table Depth ... .Rock Size .. r Distance to nearest: Well —Foundation ....... Prop. tine .L.S--------... REPAIR/ADDITION(Prov. Sanitation Permit# ................................. ---------- Date ..... ............................ Septic Tank (Specify Requirem:.; --........_ ...............-• •---.... ... ............ ..... .......... Disposal Field (Specify Requints) �. • c ....._...... ... ... .......................................•-----------. ... ._.._ ... .. ... ....................................................•------.---•-•-•-----•--••- (Draw existing and required addition an ..............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. Hahne 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." t Signed . Owner By ......... ..... ... tie ..... ................... (if other than owner) FoR O/PARTMENT USE ONLY ' 6 ... - ....................... .... .. DATE APPLICATION ACCEPTED BY�,-`.. ... BUILDING PERMIT ISSUED ................DATE ...................................... ADDITIONAL COMM NTS .............. .. .... ._.. -lh'=�G• ..... _ `---- -G'1•%r- :::.............:-.-.::._-...•::::._-^...::.::::::..................I ........::::..::::::.::.:::::....... ......::::::... -.--.-In-s" ................. ........... . ........................._................. ...-- •. - ........................................I.----- Final Inspectsnn by: ° ..........................••-....-.............-.........-.--....--..-.Date .�'-:.f... -,��.-.........---... ESI 13 24 1-613 ' � SOAQUIN LOCAL HEALTH DISTRICT 8/74 3M �/ C43