74-615 - Laserfiche WebLink

Home Browse Search

MFOR OFFICE USE: APPLICATIONFOIL SANITATION PERMIT .......... �z-74._.._.t2.. )complete in triplicate} Permit No. ..7.`� _._..-•_.-•............................................• This Permit Expires 1 Year From Date Issued Date issued Application is hereby made to the San Joaquin Local Wealth District for a permit to construct and install the work herein described. This application.is made in compliance with County Ordinance No. 54$ and existing Rules and Regulations: i JOB ADDRESS/LOCATION .:. ._: ..�� ...5; _ ti e�f......_...CENSUS TRACT f�/..LSD•- — / � . gra /S'��-. Owner's Name /R../.._...- � ...�. ........ ........................•------- ........----...---Phone ...........-...................... Address .... 1....-...J.f. . . "/. .....................----- ------------ City rf -- -- �" ......'_.................-.............. Contractor's Name ........................................ ...................... ....................License # ........-............._. Phone Installation will serve: Residence ❑ Apartment�House-E] Co7mercial ❑Trailer Court ❑ -------------------------- Number of living units:.......... Number of bedrooms -..____.Garbage Grinder Ah-e/7—tot Size __. .f`.._ A Water Supply: Public System and name ..............._.........---...-----...................--...............------------ Privateer — w CCharacter of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay,❑ Peat❑ Sandy.Loam Clay Loam ❑ r �f so �.d � mow.t � ;,...� 'L - Hardpan ❑ 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.)4) NEW INSTALLATION: (No tank or seepage pit permitted if public sewer '3 availab within 200 feet,) N �1-9.d. �,Y✓ PACKAGE TREATMENT [' SEPTIC TANK ] Size---- ----------------- ----------------------- Liquid Depth -----.... ........ Capacity .. Type .._---... --- Material.--- . ..... ....... No. Compartments --.---.-__._..._...i I Distance to nearest: Well .'. -k� a_- ---.-----Foundation ... Prop. Line ...................1 LEACHING LINE [ ] No. of Lines ... .... .... Length of each line .... Total Length -------- 'D' Box .. Type Filter Material -------------------- ypDepth Filter Material ...... r Distance to nearest: Well _..� � . . `__... Foundation I/�._f' ..... Property Line_ ... .__ C SEEPAGE PIT [ ] Depth . `U _... Diameter ................ Number ._......................... Rock Filled Yes ❑ No C] Water Tabie Depth .............. --------• -----------..--------Rock Size --------•----•-• --- ----------- Distance to nearest: Well ------------------------------- --------Foundation ... . ....... Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# ----------______----------------- __________ Date ------------------------ ...... Septic Tank (Specify Requirements) ............. -------------------------------r-------------------------------- Disposal ------ .---------.--.Disposal Field (Specify Requirements) .-.--- -•--- --------- ------------ -- ....... .----------------------- (Draw existing and required addition on reverse side) 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: "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 swbiett to Workman's Compens t' n laws of California." Signed .:� _ .. . .... --------------------- ------- Owner By ..,. .. _....._._ ... .._ ---------- ...................................... Title . ... ............... (If other than owner) FOR D RTMENT USE ONLY APPLICATION ACCEPTED BY i ................... __../ ..............._-.._---- ---._-•-. DATE ............. BUILDING PERMIT ISSUED ....................---- DATE .. .........................__............. ADDITIONAL COMMENTS_--....... ......... ............... ..... . . ...-----•-•......... ............ --..- -.----. _..�: .�. :...--------------.........._..------•--- _..--------•........................S71. . . .... --------------------,.._.._. ......--- •--••---•---.....---------Final Inspection by: -. -- _ 1 _ . - .. ------- ---------------------•-----------------_..- Date,--. - 7X............ SAN JOAQUIN LOCAL HEALTH DISTRICT