|
FOR OFFICE ELSE,
<br /> APPLICATION FOR SANITATION PERMIT
<br /> .. ,. ...........
<br /> f,.•,..,..•................••�•.... ...
<br /> iV .. '..::.... ... lcomplot#in TrlplkaMZ, Permit Ido. ..7:
<br /> .... n.
<br /> This Permit lxplres 1 From Daft I T Date Issued .1 175,.
<br /> ........................ _ Year ;� . .
<br /> Application Is herebyy made to the'San'Joaquin Local Health District for a permit to constnitt and Install the work heroin
<br /> described. This application is made incompliance with County Ordinance.No. 549 and existinq.Rules and Reguf0flons,
<br /> ,108 ADDRESS/LOCATION ,010 .E Fremont
<br /> Owner' Dora E. Schi e6'Ter. ........... ... ............ .... . ............................Ck iUS TRACT ..................:.....,..
<br /> s Name
<br /> ...................................................e...........:........Phone ........
<br /> 'Address :010..E.:...Fremont
<br /> Contractor's Name ..:..ROTO ROOTER SEWER SER.'.,,......... . ..:City ..........S:LRsikto ? --.... ..................
<br /> ... .... .............................License ' ..•#(�7�5 forte ..............W-2616 '
<br /> lnstnllation will. serve: Residence M Aparement House{ Commercial ]1'ra!!er Court ......., ' ...
<br /> Motel❑Other............ .......................
<br /> Number of living. units:.... .. ; Number of bedrooms ...... ....Garb a Grinder•x��.. ..
<br /> .. ag . .. Lot Size ..�...,a.Qj?.e...,......,:...........
<br /> al i.. Water Ser'.
<br /> Water Supply: Public System and name....::...I"e..............................................:....„,...............::..............:.............Private#[ .
<br /> Character of tall to a depth of 3 4614 Sand 13 Silt 0 ' Clay. © Pact Q Sandy loam C3 Clay Loan 0 I
<br /> Hardpan Adobe C Fill Materlaf,moo,.....if Yes,
<br /> (Plot plan, showing :ice of lot, location of system In relation for wells, buildings, etc, must be placed an reverse side. ,
<br /> NEW INSTALLATIONS IN* septic tank or seepage pH
<br /> permitted If public sewer is available within�feet,)
<br /> PACKAGE TREATMENT I I SEPTIC TANK( } - . $ixe................. .... Liquid Depth
<br /> i ....,... ..,....,...,
<br /> Capacity .................... Type ..... ........... AAabrlai............... No. Compartments :1
<br /> Distance.to nearest: Well ...... ..,...
<br /> .....................Fou
<br /> LEACHING LINE .I No. of Lines. Lengthy of cartelitte. ndotiorr . - :.:.:.... Prop. Lute: . .............
<br /> .� ,.. .... .. Total length ..
<br /> V Box ....,.. Type Filter Material ....................Depth Filter Material .:............a.. ........ .......
<br /> Distance to nearest: Well .... .........Foundation .. ......... Properly line ...............„......,Np
<br /> SEEPAGE PIT [ } yDep* ................... aiamebr _...:. Number .... ... . . ........ Rack Filled Yes ”
<br /> Water Table Depth ............ ............. ......Rock sitcee :..:....... .
<br /> 'Distance to nearest: Well ........................................ �: -....
<br /> i PAI ADD .Foutedation ..................... Prop. line ....
<br /> R/ ITION 1Prov. Sanitation Permit# ....... ................. {ktb
<br /> Eg, ...: `
<br /> Septic Tank ISpecify.Regvirements! ......:.... :..
<br /> a i
<br /> €�cic� 1 �• eaa =.ted. : 3r',•-f3a-a:.: bar:. . .. ......
<br /> Disposal Field (Specify Requirements)
<br /> ........................................................ ..............................................
<br /> ...... ....... ..................
<br /> ............................................. . ...... .......------................................• . ..-........: .... .. ....... ......................-.... ..,.....:.. l !
<br /> {Draw existing and required addition on reverse alder. ..fi.. '��
<br /> • .
<br /> 1 Rhereby certify that 1 have prepared this application and that eke work wily be .:ori M accor&nco wills skin
<br /> County Ordinances, State Laws, and Rules and Regulations of the ton joagvla Local Health,District.Hatt+s owner ar ligm '
<br /> sed agents-signature certifies the following: ,_
<br /> "I certify that In the performance of the work for which t
<br /> h
<br /> i
<br /> srrel# is.peissitod, 1 shall not employ any person In eueh`nranow E
<br /> as to beco e s blect to Workm4mpens,tion laws of California.” ,
<br /> Signed ... Owner
<br /> By .............. . ... ... Title :......
<br /> ....................... ... .....:...._..
<br /> other"than ont'r �toll t
<br /> FOR DEPARTMENT USE ONLY
<br /> Y
<br /> APPLICA 10 ACCEPTED BY .. DATE .1,11 ,.
<br /> BUILDING ERMIT ISSUED ...-.-. ...................
<br /> .:......................•............ --DATE .A1]D#TIONAL COMMENTS.................. ............ .. . ........... .......e ...;...----.. •.�.....-......a. ....................................................... .... `..-. ...-....._......... .... .,.
<br /> Final Inspection by.. .... ......................................................: . ..... .... I
<br /> EH f %` Date ...../.. ,.. ......
<br /> 13 1-6 �• SAN JOAQUIN LOCAL HEALTH DISTRICT �
<br /> - VA, 3M
<br />
|