76-165 - Laserfiche WebLink

Home Browse Search

FOR OFFICE LISE: ..- . .- APPLICATION FOR SANITATION PERMIT ............ -_. ---.. .---.._. _,` 76— /6 S ................. (Complete in Triplicate) Permit No. ....................• ................ 0....... ........................ This Permit Expires ! 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 .._...-.-13.7sD... - ?_/ S:T�CY.._e�L' %. ... .. ..... ........-,............CENSUS TRACT ....._,-. ................ Owner's Name Z .......................................... Phone ...-�?7,31.-.30!( Address 137-7 --- 744,,44-574tr'- 4�......................................City '7ir�. .. ..- Contractor's Name .......... ........................................................License dE ... Phone Installation will serve: Residence❑Apartment House C] Commercial❑Trailer Court C] Motel❑Other............................................ Number of living units:-.-5 I _ Number of bedrooms .. `....Garbage Grinder ............ Lot Size ... ....:!-� :.................. Water Supply: Public System and name ...............................................................................................................Private❑ Character of soil to a depth of 3 feet: Sand IS Silt❑ Gay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan❑ Adobe❑ Fill Materlol ............ if yes,type............... ............ (Piot 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 [ ] SEPTIC TANK£ ] Size_•---___.1'...6............ ........... Liquid De ype -•-- - .._.._. Capacity ---j.i`C- _-_ T 1 � __. Material.. No. Compartments ...rte-j:. ........ 0 Distance to nearest: Well _... �......................Founda ion .......41... Prop. Line N LEACHING LINE [ ] No. of Lines _J---_-------_-- Length of each line...,---_-_.�-!�___--_ 4-,1 Total length ..740................ 'D' Box __. Type Filter Material f __,_ _-_-_..Depth Fitt r Material .,.11/1........... ..... . ........ . Distance to nearest: Well ..... _._..__ Foundation ... ... :............ Property Line . ...............•Ny SEEPAGE PIT [ ) Depth -------------------• Diameter ................... •___._________:__Number .........-,,,1_„-,- Rock Filled' Yes ❑ No i❑i, Water Table Depth -•....................••---.._.._..__ .,.._......Rock-Size •-----•...................... _ Distance to nearest: Wel( ......•............................V..-foundation .................... Prop. lne....................... REPAIR/ADDITION(Prov. Sanitation Permit#t ................. ....... ---. (late ................................... Septic Tank (Specify Requirements) ------------------ ...................-.......................................................... Disposal Field (Specify Requirements) ....................................................... -- ------------------------------- -------------------------------_-.------ -----------•._- =.................................................................................................... (Draw existing and required addition on reverse side) I hereby certify that 1 have prepared this application and that the work will be done in accordance with Son Joaquin County Ordinances, State Laws, and Rules and Regulations of the'inn Joaquin Local Health,District. Home owner or 11con- sed agents signature certifies the following: "1 certify that in the performance of the work for which this permit is Issued, 1 shall not employ any person in such MGIMW as to become sect to Workman's Co, ensation laws of California.•' Signed --- 'rL �” . g Owner By - - •-- ................... Title -........ - ............... ........ (If other than owner) FOR D rARTMENT USE ONLY ' APPLICATION ACCEPTED BY f -•-•- - --.... ..,,__. ---- ............. DATE 2. . zc%�. .... .- ---- - BUILDING PERMIT ISSUED ..__4-:_♦.-,--.-_... „ DATE . ...... ------•----- - .. .. ............... ADDITIONAL COMMENTS - ...............................................:.......... ...... • - •--•.._.. .............. - ----------------------- ............................. ....._..._- ..........I--- . ...........-..............,.............---------- -..... ---------- ................. •--••----- ---- -.-...---------.___----_ -------------_„-,-------..-.._,..-. ---,.--- ----------.........---•----._.-...-..---- - ----• -- ....... ........------------ --------•--------- ...-._.,-.-......_..-•---- .....-- Final Inspection by: . f -�C.__..._. • _--------_- - ,_„............. Date .�� .... ..._..--.. IIP 13 21{ 1-613 Rev, 5m SAN J AQUIN L L HEALTH DISTRICT 8/7h 3M