75-193 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATf0N FOR SANITATION PERM � ........ .... � Permt No. ..Z .I 3 e .. ......... 0........................................................ This Permar it Expires t YeFrom Dote Isswd Date 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 Regulotkmss JOB ADDRESS/LOCATION ....ORKNO.�.DOCTOLERfl (Orbonp. j}p� . ......................... toll( rM)....I.........CEI S" TRACT .......................... Owner's Name ... . ............... 281.•S�s-Ash• tx.............................. .Phone ....464 »?464 Address _. .satrie... .......................................... ...City .........S.tc�cktoxt,--•--••----......................---............ Contractor's Name ....................�? _A-;•_Parrish-.�C Sons,- Inca.._.........License # ........................ Phone ..._..... Installation will serve: Residence akApartment House f3 Commerdal QTrailer Court 0 Motel❑Other............................................ Number of living units:...)...... Number of bedrooms .....2..---Garbage Grinder ............ Lot Size ... .................... Water Supply: Public System and name ................................. ......_._.......... .......Private Q Character of soil to a depth of 3 feet: Sand j] Silt Q pay 0 peat 0 Sandy Loom Q Clay Loam Hardpan Q Adobe 0 Fill Materlol .....I......if yes,type............... ............ (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 seepage pit permitted If public sewer is available within 200 feet,) PACKAGE TREATMENT [ I SEPTIC TANK f ] Size...................................I............ Liquid Depth .......................... Capacity .................... Type .................... Mole rial...................... No. Compartments Distance to nearest: Well ......... .......................Foundation ...................... Prop. Line...................... LEACHING LINE [ j No. of Lines ........................ Length of each line............................. Total Length ............................ 'D' Box ....... .... Type Filter Material ..................Depth Filter Material ............................................ Distance to nearest. Well ........................ Foundation ........................ Property Line ........................ SEEPAGE PIT ( j Depth .................... Diameter ................ Number ............................ Rock Filled Yes Q No 0 Water Table Depth ................................................Rock Size ................................ Distance to nearest: Well ........................................Foundation .................... Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date ..................................) Septic Tank (Specify Requirements) _ STING . ..... ...................... ............................I........................... Disposal Field (Specify Requirements) ...........................................................SUPPLEMENTARY DRAINAGE: 40 f t, lea chin drain .......................... •-•-----•---•----------------------------- (1) 33" x 251 seepage pit --------------------------•--......._.....-•------•--••..............---•-- -- ------------------------------- ...................................................._............................................................................................ (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 Jac gain County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Heal#Is District. Hance owner or lieon- sed agents signature certifies the following: "I certify that In the performance of the work for whish this permit Is Issued, 1 shall not employ any person In such manner. as to become subjW to Workman's C &mpensatlon laws of California." Signed .....0z_ By ----------------------------------- ------------------ Title ....Estimator .... _ __.... (If other than owner! FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .... . •-.- - • • ----•--•------------••-.. DATE BUILDING PERMIT ISSUED ------------ --•--•-- -------- •.... DATE . _. ........... .............. ADDITIONAL COMMENTS ............---.............................. .................... . .......................................---...... ----------• --- ........ .... --- .....................--................. -- -•-•--.:.--- ----- --..... . .............. ................. .... "/ ..... ............------ ---------------•---- ............. .------ ---- . ... . ... . . ........ Final Inspection by: --------- ---•---- ----------- ------------------- / ------ ------._.. .. .. .-..�".J... . - ... ----•.... ...... ... . ........... ..... ....:....._........-..Dato ..... ....... 13 2!i 1..613 l�ev. SAN JOAQUIN OCAL HEALTH DISTRICT 8/71 3M