72-78 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: I APPLICATION40R SANITATION PERMIT Permit No.- -- -- ------- --- -- --- --- ----- (Complete in Triplicate----------------------------------------- Date Issued . .. _. ' This Permit Expires 1 Year From Date issued e work Application is hereby made to the San Joaquin om jiiance Local Health DytOrdinarict rn a permit and existing Rules tand hRegulat ons herein described;This application rsGr7�91 p. "t d TRACT --• CENSUS JOB ADDRESS/LO ATION Q---- ---1`-; Owner's Name Ph ----------------- -------- �� C C, City _ -•-------•-- Address __ ------ -9 Contractor's Name k.t + S ,ti's, _-, . 1 C4 VLicense # Q$--}'I Phone !�� f Installation will serve: Residence Apartment House'❑ Commercial`❑Tra;lei Court :E] Motel ❑Other ---------------------------------------•---- � � __ Lot Size ----- Number �� Garbo e G in er Number of living units:------- Number of bedr!o�oms ____________ 9 � ,r,, � Private !`r'r vu ------------------- Water 4 Supply: Public System and name ------------- ___--_____ _ - .. Peat Sanr",r, Loa ❑ Clay Loam ❑ Character of soil to a depth of 3 feet: Sand Silt❑ Clay '❑- ❑ i Hardpan ❑ Adobe E] Fill Material ------------ If yes,type -------------- - showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) Or (Plot plan, sh g NEW INSTALLATION: (No septic flank or seepage pit permitted if public sewer is available within 200 feet,) A i . Liquid Depth ------- - �--- �g- x PACKAGE TREATMENT SEPTIC Size Capacity Type ----------- Material No. 9mpartments ----- /`1V---- ----/ , • 17� Distance to nearest: Well __________ __ _ _ Foundation 1 ___ Prop. Line .___sJ. -: --- --- -- ------- t ---._ _____ Length of each line_---.__ �--------------- Total Length ---- LEACHING LINE No. of Lines ________ /!4 G-_ epth Filter Material ______-��d------------ --_• t #� 'D' Box ____-I---- Type Filter Mate rialf�Y-� s , Fou da ion -----1� - -_ Property Line. _. Distance to nearest: Well ____.___ ¢. w. , *E , Rock Filled Yes No 0 Depth Diameter ---------------- Number ------------------ 4.SEEPAGE.PIT [ ]X p ; ;r p „n� ,�. Rock Size -------------------------•------ v Water Table De th `-- - 4 -Foundation -------------------- Prop. Line _. -------------•----- " Distance to nearest:°Well i I -- Date k ------------------ ) REPAIR/ADDITION(Prey. Sanitation Pei t#4------k; -------------------------- , / ---------- ----- Septic Tank (Specify Requirements} ____________ __ __ '--------;� ` /Z)-/-3-71 .CGS f i Disposal Field (Specify Requirements)'- ------ - ---- -- ---------------- - 9.. --------------------------------------------------------------- ____ - (Draw 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: t erson in such manner "I certify that in the performance of the work for which this permit 1s issued,;l shall not employ any p as ecome subject.to Workman's Compensation laws of California," Si ned Owner - --_ BY y ------------ ----------------- Title th n owner) �. • FOR'DEPA1tTMENT USE ONLY y � APPLICATION ACCEPTED BY -- ------------- - -- ----- --------- --------- --------•__. DATE - - o� --�=T..---- ---•----------- BUILDING PERMIT ISSUED ------------------------- -------------- ---- DATE = ADDITIONALCOMMENTS ------_------------------------------------------------------------------------------------------------------------------- -------------- -------------------- ------------------------------------- -----,---- Z -- - -- ------------- ------------------------- --------------------------------- ---------Date Final Inspection b __ __ - - ---------------------------------------------------------------- --- -------------- - ---- - - ------- SAN --- SAN ,JOAQUIN. LOCAL HEALTH DISTRICT F H. 9 1-'b8 Rev. 5M