75-538 - Laserfiche WebLink

Home Browse Search

Vw_T_ FOR OFFICE USE,. APPLICATION FOR SANITATION PERMIT Permit No. .............................. .............. .............. ACOMplot9in Triplicatel., ...............••-••..........:........._..I....... ....... Date Issued ......... ....... .........................I.......... This Permit Expires 1 Your From Date Issued Application is hereby made to the Son Joaquin Local Health District for a permit mit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: !OB ADDRESS/LOCATION Lathrop- .... ............aNSUS TRACT ................I.__---••• .............. ....... ... ... Owner's Nome .... ------------------------------------------Arlene Luk etta------------ ............--h................. .................................Phone ......... ---------------_-------- -ity .................................. ................ ............ ........................................ Address ............s,ame-------'...... .......... Contractor's Nome -----Ro.tc)--- _-•-•-'--:----- ..License# X71539_..._....... phone4 . �..-2616 ............. ........ Installation will serve- Residence 0 Apartment 1 to u L Mwfu] "e MA?l qT6 Sh F*4�O I Motel0 Other.... ........................................ Number of living units:_._.-___.._ Number of bedrooms _-a.—Garbage Grindsr'V��..... Lot Size X ------- ................. Water Supply: Public System and name ......... .......................... ...................—.7-................................ ............Privcft 0. Character of soil to a depth-of 3 feet- Sand'E] Silt 0- - Clay..I3 Peat 0- Sandy,Loam 0, Clay Loom 0 Hardpan 0 Adobe OFill-Waterial 112.-;w—If ........... ........ Plot plan, showing0 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 wilthih 200 feet) PACKAGE.TREATMENT SEPTIC TANK fx] Size—W....bY..5J----b--Y9.!......... Liquid .Depth -44!.................... Capacity 12QQ.&....... Typop_re.7:.9.&q-�. ., Material No.- 2 Compartments ...................... In 11 .50 ' Plus 10 -----••---------------1 - Distance to nearest; We —................................Foundation ---...t-......... Prop. Line LEACHING LINE No. of Lines ......2........................ Length of each no.........70...,...7.....0.. Total Ler ....__1 �.-------...... 'D' Box .......yes • Type filter Material r .rock....................Depth Filter Material ............ ........ .................. Distance to nearest.. Well _50!............... Foundation ...J.W.............. Property Line 5.1.................... vj SEEPAGE PIT ( I Depth ........._.-•-..--.. ........... ....... Diameter .......... Number .............. ........ ... Rock. filled Yes 0 No 0 ............. Water Table Depth ........ .................. Size ... ............... Distan6e to nearest.. Well ............ .....................Foundation Prep. Line . REPAIR/ADDITION(Prev. Sanitation Permit# ...............................t--------- Date ............. ............ Septic Tank !Specify Requirem: ents) ................... ................... ....................I.......... ...................................................... DisposalField (Specify Requirements) ......................................................m............................... ........... ---------- ------------ ------------I --------7------*------------ ........ . . ... ............... ...... ........................ .... . .......... --------------------------------------------------*-----------------------------------. •-`_._--. --------- _•--..................--- ---..........*.................................................... .. .......................... (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 Ordinance,,, State laws, and Rules and Regulations of the San loaquIn local He,1114,I)ISIrict "am* 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 become subject to Workman's C mpensation laws of California." Signed ------------------- ------ --- ------ ------ --•-------------.._.....---------._,.._ Owner Cbntractor . BY ---------- --------------------- .. ......................... .. ......................... .......... (if r than owned EPARTMENT USE ONLY APPLICATION- BY _--------- --------- ------.,DATE ,,...-. -------I......... BUILDINGPt0MIf 'ISSUiHb ------ ------------ -----------I-------I............................ ------------ '._--------DATE ................... ...................... ADDITIONALCOMMENTS ----------------------------------------------------------------- ------------- ---...---....--••--........_....,.. .._ _..................................... ------------ ---------------- ------- -----------------------------------------------------------------------•-----._._......-...... --------.._.....-_._._..._...-•-- ........................ 1114k ....I.................. . ................. ---------------------- - --------------------- 7 ------ ------ Final Inspection by. ------!... ............................ -----------------------...-Date.. .. .. . ........ ............ �51 ................ ..................... EH 13 2h 1-66' 11ev. 5M SAN JOAQUIN LOCAL HEALTH DISTRICT8/74 3M 0