77-260 - Laserfiche WebLink

Home Browse Search

USE: - APPLICATION FOR SANITATION PERMIT ... ............ Permit N _ tCanpleto to Triplicate) � i ... .......... .................. This permit Expires I Year From Date Issued Date Issued Applicatiah is hereby made to the San Joaquin Local Health District for a permit to construct and Install the work herein described. Thls application is made in compliance with County Ordinance No. 544 and existing Rules and Regulations, JOB . ADDRESS/LOC TION ....-.../O .57... CENSUS TRACT &(a Owner's Name ...4.. 14f........ f ? .rs.....................................................................Phone.,1't'11;. i:.........., *�.--- Address ..._._.. .�d 5.. . (i.... R�t/ t .................. .. ..........City/ Y.t';. ... .........---............---...................... Contractor's Name .....OLS-041.......... .G..tc.........................License#.'r:L .`, ;T • Phone S*e,' ;P••'�1`j��' Installation will serve: Residence JE Apartment House's Commercial oTrailer Court 0 Motel0 Other............................................ Number of living Units:_._ ...... Number of bedrooms Y_.......Garbage Grinder�k.F.. Lot Size .._f �:.( . .5...___-__•____ Water Supply: Public System and name ........................................................_......._................ -..... ..... Privates j Character of soil to a depth of 3 feet: Sande 0 Silt Q Clay a peat j] Sandy LownX Clay Loam 0 Hardpan 0 Adobe❑ Flt)Material............ if yes,type............. ............ (Plot plan, showing size of lot, location of system in rotation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is ovailable�vwithin 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK{ j size........ 2 ....cry......... Liquid Depth AC.-. .0' city/2,&,c•- ype .ol-P.'rA�.t Material.eOnt:'- No. Compartments 0 Capa `� T � pa menta �... . ..-----.... %A Distance to nearest: Well .../. G.10�_..._�_----._Foundation .-/.,D............ Prop. Line LEACHING UNE [ j No. of Lines ;�........... Length of each •11ne...... W. ...... .Total Length ..2, *. ...... Z 'D' Box ..,/'...... Type Fliter Material ./kA pth filter Material ....2_1rL_In,8_2.._ _, DisMnce to nearest, Weil „�, r FoundationProperty ... �` SEEPAGE PIT, ( I Depth .................... :Diameter _............... Number........:................... Rock Filled Yea Q �Q Water Table Depth ....... .......................................Rock Size............. .................. Distance to nearest: Well .......................................Foundation .................... Prop.. Line ...........__......... J REPARVADDITION(Frev. Sanitation Permit# ...... .................................... Date ..................................) Septic Tank (Specify Requirements) ............................. ............. . ......_ ................................... ............. ......... Disposal Field (Specify Requirements) ................................ ............................... ............ .................................................... -------------------------------------------•-- ...-••----•-------•--••-----•••--... ....._.......----......----•--•-------.............---•,... ............................ (Draw existing and required addition on reverse side) I hereby certify that I have.prepared this application and that the work will be donho M accordance with Sank Jeaquln County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Hearth Dishiet. No"Owner of )lawn• SW agents signature certifies the following: "I certify that in the performance of the work for which this permit Is issued, 1 shag not employ any person In such wanner as to become subject to Workman's Compensation laws of California." Signed ............... ..... •... Owner By ............ r - - ----•--- Title ----- . ........................ owner) iA R ARTM T USE ONLY APPLICATION ACCEPTED BY ...... = ............. .........-...._._......._..... DATE ..« .C' --•- ...... BUILDING PERMIT ISSUE3,.,,,,.- / -_----.------ DATE ADDITI NAL COMMENT9�El.��-- v ..�!Tt�ItQ.._../. /r' , .. . .. q .................................. ........... ....................... ............ ... . _..__... ...... _. .. Final Inspection by: ....... ... . ....... ........ : ............... EH 13 2h 1-68 5KSAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3 �- r