76-1010 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATI4 Trl��- vellml,-•.......................• ..................._.._.... (Complete In TriplicaN►) it ................... . This Permit Expires 1 Year From Dataisuod Date Issued .1.. .-. -7.� 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 Ordin No. 9 and existing Rules and Regulations: JOB ADDRESSA ION 4&I-2-4c...... .... .................CENSUS TRACT .......................... Owner's Name ..._. �1/j /'�G'�� '��- .....................................I................' ...... . . .....Phone ..��,�'��...... Address- -4, _-' . ._ icl_. .5 .... ..............•......City ....�►`4!�.1-- – ...........I............ � �� `- Contractor's Name ---- - _-- - -----�.��......._. .. ..........License ill ........................ Phone ... .... ..........: Installation will serve: Residence® merclal Qfrallor Court [3 MotelQ Other............................................ Number of living units:----/------ Number of bedrooms/-o--Ga Grinder ............ lot Size ... s�615.............. Water Supply: Public System and name �,,,e ........ d ...'...11.111.` U-6...._....................................................Private Q Character of soil to a depth of 3 feet: Sand'Q Slit Q Clay ❑ Peat Q Sandy Loam 0 Clay loam Q Hardpan❑ Adobe 99 Fill Material ............if yes,type............... ............ (Plot plan, showing size of lot, location of system In relation to wells, buildings, etc. must be placed on rovers side.{ NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,( PACKAGE TREATMENT ( ] SEPTIC TANK ] Size................................................ Liquid Depth `J Capacity ............. Type .................... Material...................... No. Compartments ......................r.! Distance to nearest: Well ....................................Foundation ...................... Prop. Line ...................... LEACHING LINE [ ] No. of Lines ........................ Length of each line............................. Total length ............................ V) 'D' Box ............ Type Filter Materia) Depth Fitter Material , Distance to nearest.. Well ........................ Foundation ........................ Property Line ........................ 17 SEEPAGE PIT E } Depth .................... Diameter ........•. Number ............................ Rock Filled Yes ❑ No 0 Water Table Depth .Rock Size -l' Distance to nearest: Well ........................................Foundation .................... Prop. line ...................... o REPAIR/ADDITION(Prov. Sanitation Permit ........ ................. Date ..................................j V• Septic Tank (Specify Requirements) ........................... . Disposal Field (Specify Requirements) ...........I..................... ...............................................•........................................................................................................ . (Draw existing and required addition on reverse side) 1 hereby certify that 1 have prepared this application and that the work will be done in accordance with Son jo"W" County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Heade.District. Hence ewwer or licen- sed agents signature certifies the following: "I certify that in the performance of the work for which this p*mit is issued, I shot not employ any person In such manner as to become subject to Workman's Compensation laws of California.,, Signed �G �. ---- _- Owner ,f — / Sy .. .. - s��r.---.-._.... Title --, �7`/.. JAG �`d .......... (if other tha wnerl FOR DEPARTMENT USE ONLY ' APPLICATION ACCEPTED BY _......... ...............................-•-----•------............... DATE -.-/y BUILDINGPERMIT ISSUED ... .. ... .. . .............. ......................................... ------------ ..............DATE . ---- -.......-- ................. ADDITIONAL COMMENTS ... .... . ............................... ._..__.............._............... .. ..:..-...• . ........:. .................... ................. •-----•----•----------••---- -------- ............-...............--............---.-...---- --••-- .._..----...-•----.................._.........,.._ -------------------------------------- ------- t ...................•........ ............................................................................................ .... -------- --------------------- ----- ... -- Final Inspection by: --- --- -. . ......:.. ..._:.._ Date . - EH 13 2h 1-68 N AQUIN LOCAL HEALTH DISTRICT 8/79 3M C