68-864 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: _ APPLICATION FOR SANITATION PERMIT ----------_-------------r._______--k:%-_._____-________ (Complete in Triplicate} � - �- -' Perritt IVo- -------- ------ ------ ------ ------------- Y------------------ -_____ -_____ This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION .---------15T64 _5 t-h tree t Lathrop-------------------------------------------------q ---------------------CENSUS TRACT ----- Owner's Name -------------- etpr--3a-ndo_va-L----------------------- --------------------4 ' Phone ---.Address -------- _/ -- < Contractor's Name {V �� ----------- Cityr-------- ---------------------- -----------•-.=_' -4-------.-_-------- -- -=- - •--------------- ----- ----------- - -------License # -------- -- ---------- - -------- --- Phone -----------•-------- -- • _ _.. Installation will serve. Resi ence ®Apartment House❑ Commercial ❑Trailer Court i❑ / a Motel ❑Other Number of living units------l_____ Number of bedrooms __3-------Garbage Grinder _t"-o------ Lot Size 50X__160 enc 2 alley Water Supply: Public System and name _____________Lathrop 01 T� wR T -------------------------------- ❑ Character of soil to a depth of 3 feet: Sand Sift❑ Clay ❑ Peat❑ Sandy Loam. Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material ------------ If yes, type ---------------------------- (Plot _____--.___ _-_(Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepa a pit permitted if public sewer is available within 200 feet) PACKAGE TREATMENT [ 7 SEPTIC TANK 12-04----------------- _-__ [ Size--- - - - ------------ Liquid Depth --------------•----------- \ Capacity --.__1200____ Type _precast- Material__---ggPc------- No. Compartments Distance to nearest: Well nOrIr_------------------------Foundation ---IQ-------------- Prop. Line J0___- � RING LINE [ ] No. of Lines -2-------------------- Length of each line--- ___ -y�D Total Length 180 'D' Boxaanr_-- Type Filter Material OGK---Depth Filter Material --_______f� Distance to nearest: Well ---UQMe----------- Foundation ____ 5--------------- Property Line l0 SEEPAGE PIT [ ] Depth _____ ----- Diameter —�.— rifle ---------------- Number -------------- ------------- Rock Filled Yes ❑ No [] Water Table Depth ------------------------------------------------Rock Size --------_-------.--------- Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ---•--------- ---_-_ ' REPAIR/ADDITION(Prev. Sanitation Permit# -------.------------------------------------ Date Septic Tank (Specify Requirements) ------------------------------------- - - Disposal Field (Specify Requirements) ---------- ------------------ �41MA!> -----BuT------NO (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: "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 Workman's ompensation laws of California." Signed _ ---- Owner ----------------------------------------------- ---- ------- - - ------- ------------ - By - ---- -- --- --- other than- owner) Title ---------------- -------------- -------------------- FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY '[-R`Q DATElJ'f6 BUILDING PERMIT ISSUED ----------------------- - - ----------------------- --------------------------------- -------DATE -------------------- ----- ADDITIONAL COMMENTS ------------ ------- --�----------- ----------- - -------------------------------------- --- --- - ---------------- ----------------------- - ------------- -- ----------------- ----- _ -- -- -- ---------------------------------------------------------------------- }� // ina Inspac ' - - - -- -------------------------------------------------- Date 1!/.-�_�E?. SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M