76-1036 - Laserfiche WebLink

Home Browse Search

i OR OFFICE USfs � " NITATION APPLiCA N hOR 5A �Parrnif'No. ...7. ...................................................... (Complete Ydpllcate} �y "76 u ..................... Date issued .. _ This Permit Expires t 'Year Erem Dats Issued ............................. rmit. to and l the Application is hereby made to the San Joaquin with CauI Health Dy+O diva a No. 549 and existing Rulestand Regula�tions, described. This application is made in compliance �.. . ...................CENSUS TRACT .............. .. .... JOB ADDRESS/LOCATION .�. .. . .Phone .................... s.......' .... Owner's Nome ..., -- .. tl ............ .............: ............_----.-..........�..... ....... Address .......... ` f.. ..............City sl�.P.. _... {_ 64c...License `t__: Phone Contractor's Name - lFis'tailation wW it s��a�'"""�''`�""Ra�idae�c��Apartment'i�lDose-i]-Garnmercia!-�TraNar•CourtT� •-•-�---•—•�.--•.� Motel(]Other............................................ / I } Garbage, . Lot Size �....... Number of living units:.....I.. Number of bedrooms . Grin - � I Water Supply: Public System and name . •- •�sf - ' -2-4i- ............................... . .......•-•- .Private.❑ i Clay'(] Peat❑ Sandy Loam{]. ..Clay Loam n Character of soil to a depth of 3 feet: Sand❑ Silt Q , .... Hardpan Adobe fill Materia! ............ ifya:.hl�.. .; .. ..... ... I • 1Piot plan, showing size of lot, location of system in relation to walla, buildings`; etc. must be placed on reverse -iIsle.] I ' ALLATIONs (No septic tank or seepage it perriaitted if public sewer-is available within 200 feet,) NEW IN3TI Liquid Depth .. PACKAGE TREATMENT I ] SEPTIC TANK{ ) Sr`f ........................................ ...... f �•......� Coperclty, .................... Ty ..._..--........._'. Material...................... No. CbmPments 1 ..... --- . .Poon tion:....fi 'Prop.-tine I Distance to nearest: Well ............................ a •�. ..... IrEAG1=11N LINE No:of trines- e ......=r Length of earh� Total Length . . ... -- "% } " �, pth Filter Material ` 3 V Boic�'z.... ype Filter Material .-/�Csr� •- ...... . •; ....... ......P ation . ., . Prop* -LIna� •• .......� fir .. Found �,. Distance to nearest: Well � •-••- • Rock Filled Yes , o ❑ �...... Diametelr.� _�. Number SEEPAGE PIT Depth �• s ---- �, ----�-` --- °_ _ .. 1 '' 'w..._ ` ----Rack Size _ : �Wdter Fable 'Depth •• .� ........ ' ...... .. .. k, I _;� �- t Foundation .�...� Prop. Lina .._ .....-- . . .:.� - Distanc� to nearest: Well �-��•..........- I REPAIR/ADDITION 1Prev. Sanitation Permit# ...........................- - '©ate ..................................] �.-L. ..... ...^. {.moi�. .. . Septic Tank 1Specify Requirements) ... ................ .. .. .ti�..., .. f` "., �... ....-- Disposal Fielai 15peciFy Requirements] ... # i y r ; ' r a .. .. .. _. .......... . ....... ...........""' / •--� w;. .. . .... .. .. ., .. . { .1. �. -s. .---..f.:."---� . . .. ...�� ...::,.--•and re. uired addition an reverse side]• ....... ......._.............................. . r. D aw axis#inTg q I hereby certify that 1 have prepared this application and that the work will be done eafih Distrin Hoare owner or NCO County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local sed agents signature certifies the followings { "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 Compensation laws of California" ......... ........................ Owner' Signed .. .................................. ... ..... . ....... By ......... . :...... Title . .. ......... .... ` 11#other than owner • FOR DEPARTMENT USE .ONLY DATE .... z.. . ...� ..............: APPLICATION ACCEPTED BY ..........+... .. ............. DATE ....-.. .......... BUILDING PERMIT ISSUED ................ .................................................21172! .......... .................. ...... r ADDITIONAL COMMENTS _................................ ........ ..........••--...-..._..... ... '"R ............_....I......-.-. ................... .....---.........-...--........... _ .........................I....... ............ ....................................................•--.....I.....-. .. ........ .-...-..... 1 .. . ... .......................---......................... Final Inspection by: ........� E . I.......D ........-.Date ................. EH 13 2h 1-68 Rev. 5M SAN JOAQUIN LOCAL HEALTH DSTRICT N.