77-287 - Laserfiche WebLink

Home Browse Search

FOR�OI`FtCE USE- APPLICATION FOR SANITATION PERMIT -. . . •j`.•• (Camp€ate in Tripffcatal : .Permit No. .ZZ-7.A N Date Issued . 1 This Permit Expires 1 Year From Date Issued V Application Is hereby mod'' 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. 5A9 and existing Rules and Regulations, JOB ADDRESS/LOCATION,....aSC1..-sroZ._....... ._......8/re j_Xff_r..._.A-....- .CENSUS TRACT Owner's Name Afc.4,l�.P ....... .:.:..... '._ Cy.. (..._... ..................Phone Address ..-_..-.• cl.�'a.�.-��_.... .. � b / / ................................. Contractor's Name c�'ah = Lzr3C-1}` r---•---- ...............License # Phone f 7.5Z4?3.. Installation will serve: Residence Apartment House C] Commercial[]Trailer Court I�, �Motei ❑Other-- .._... Number of living units:---: ------- Number of bedrooms __3......Garbage Grinder --------_.-- Lot Size ------ ......................... Water Supply: Public System and name ............................. .......................... ................................ -•---:.Prlvoteo Character of soil to a depth',of 3 feet: Sand o Silt.p C€ay O Peat❑ Sandy Loam ❑ Clay Loam i Hardpan© Adore 0 :Fill Material ...._....._ If yes,type_...�'.......... ...::.... {Plot pion,, 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,j PACKAGE TREATMENT ( ]'If SEPTIC TANK f ) Size----------- -- - --- - ' Liquid Depth ..-=-•-------•-----.......N t CapOcity ...-•-----_------- Type --------"--_-•---- Material.---------- ------ No. Compartments ......................00 fAC ZNG Distance to nearest• Well ...._.__._.Foundation Prop. Line ..LINE [ l No.M of Lines -------------------...._. Length of each fine----......................... Total _Length :........................... '©' Boz ............ Type Filter Material ....................Depth Filter Material ............................................ m ,�. : •� Distance to nearest: Well ........................ Foundation �....:........._:.... Property. Line ........................� SEEPAGE PIT [ Depts h-- ------------------ Diameter ................ Number ...._._.._......____......... Rock Filled Yes'o No (39 =Water Table Depth ------------------------------------------------Rock,Size _•----•---.. ........... 4%I 01 A Distance to nearest: Well ........................................Foundation ....._.:........ ... Prop. line ..................-... ) REPAIRfAd1)ITION(Prev. Sariitation Permit# ....._._..--•---------------------_-...... Date ............ Septic f Septic Tank (Specify Requirements) ..... n __.----- I Disposal Field (Specify Requirements) ---.--- Q.. . ,,---- ---------------------- -,F----- I(� ----- (Draw existing and required addition on reverse side) I hereby certify that I havei0repared this application and that the work will be done in accordance with San Joaquin County Ordinances, State Le Ws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen. sed agents signature certifies the following: "I certify that in the performance of the work for'which this,permit is issued, I shall not employ any person In such manner as to become su ject Wo�'kman's mpensation laws of California." Signed . -C. •••..... --•-- Owner 6 ------------------------------------------ tie `` i Y ---•----•• ----------------•,----------gip....-------------....._._.._ (If other than owner) .. U EV. DEPAItTMENT USE ONLY ' APPLICATION ACCEPTED BY... ..0rf, I.. -- . _G�'-- ---------------•---•--------- ----- _.. DATE:- - -`°. .I7•_•--------.:._._... BUILDINGPERMIT ISSUED .4 -------------------- --------- ...DATE _',..---------._.. ADDITIONAL COMMENTS ._;!M______________ --------•-------- --- ------------ -----------------------------------------------------------------•---------. ••-------------------------•-•------ ----.._....... /� ; Final Inspection by. ... ''p .................. : Date _. ? EH 13 24 1-613 SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 314 ` a _