76-314 - Laserfiche WebLink

Home Browse Search

FOR'OFFICE USE: 1 ,�6 APPLICATION FOR SANITATION PERMIT .._ Permit No. , (Complete in Triplicate) T 3 ... This Permit Expires 1 Year From bate Issued date Issued .. ....e ..... 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 ...- Y' C .. .-.4�..C_�, 1✓U/. r ........... ..... ......................CENSUS TRACT ......... ................ Owner's Name �//4W,RyC .._.../-x...._. 1 r��'C � .......................................... Phone ... . Address r 22-1- ?.,f L fit/ ��.... ................. 4lG4 ..,.................. city .. ��.. ._. _ .�!�/. ....._.....-- -----....._.........._..._. Contractor's Name ....................................................................,.... .........License # ... Phone Installation will serve: Residence 'Apartment House Commercial❑Trailer Court ❑ Motel ❑Other............................................ _ Number of living units— Number Number of bedrooms ..,A__.-.Garbage Grinder y0 Lot Size ..62O.q!. ._f.67.7.& Water Supply: Public System and name .................... ....Private ' Character of soil to a depth of 3 feet: Sand' Silt❑ Clay ❑ Peat❑ Sandy Loom o Clay loam ❑ Hardpan ❑ Adobe❑ Fill Material ...._....... If yes,type ............... ............ (Plot plant, 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 i ] Size......../_�.................... Liquid Depth •---•--•.................. Capacity -------------------- Type ------........ pterial--------------••-•---- No. Compartments ...................... �11 Distance to nearest.� Wel) ------ -/_ Z ...........Foundation ...................... Prop. Line ... ................ "] LEACHING LINE [ ] No. of Lines .............. .. . r . . ----- Length of each line._.�_�.................. Total Length ............................ V Box ------------ Type Filter Material ....................Depth Filter Material ......................-...--............... Distance to nearest: Well ------------------------ Foundation .............. ...... Property,Llne ........................� SEEPAGE PIT [ ) Depth .___.__------------ Diameter --- -------- Number -_.---_-------__........ Rock Filled Yes ❑ No Water Table Depth -•-----.--_---- ----------•---- •- _--------Rock Size ....---..................._ to Distance to nearest: Well ----------------------------------- Foundation .................... Prop. line .................. REPAIR ADDITION(P v. Sanitation Permit# ......�-----.------.. ........... Date .................................. Septic ecify Requirements) ..........T�_.n,�__...•. U...�._�-�� ------- ----- ,- - ...... .I.----------------------•..... Disposal Field (Specify Requirements) -------------------------------- f - --------------------------------- -............... .............................. (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 Son Joaquin County Ordinances, State Laws, and-Rules and Regulations of the San Joaquin Local Health District. Home owner or licew 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 suoect to Workman'sCor" ensu#io s f alifarnia." , Signed ----- -�•-- Owner BY ..._....- (I of er than owner)----•------------------ .. •--- ----- ... Title ------------_- ------ ---------------------------- _ R DEPARTMENT USE ONLY �L APPLICATION ACCEPTED BY __ v" \ - DATE `x'77 BUILDING PERMIT ISSUED -- ---------•-• -- DATE •--........ --------- ---- ---------. --------- ADDITIONAL COMMENTS -------------------------- ---------------- •--------- -------------------------..------------ -------------- --------------•-•-------------------•--•-••---------------.....-.-....--......---------..-..-------------- •-•-••---.-------. ------------- .-._... .. Ina Inspection by- ----- •----•• /-f .............. EH 13. -----...Date .. .. 21� -6t3 itev• SAN JOAQUI LOCAL HEALTH DISTRICT 87]1 3M