73-304 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: l DaI 'PiP'L4W`I0 f OR SANITATION PERMIT ..............•-•-. t �` 'Com�etein Triplicate) Permit Na. ...�. .. ?. .. ....... ................•---... .......... ......... ....... . ... . . . _ . . � This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the Joaquin Local Health-Dist ' + q rict for a permit to construct and install the work herein described. This application is made rn compliance with County Ordinance No. 549 and existing Rules and Regulations: .I , /fi f r I `.. 43 JOB ADDRESS LOCATION _�,'$!.. _-.• •� ,�F.�.-•�.-•�� CENSUS TRACT �................... ...... Owners Names v C "` .............: �... __... ......... .---...... Phone ..------------._.._.................... Address ....................... _3N . ........ �r..... ....... City City Contractor's Name .-.� ..--_ Zft ---------------------------License'# , Phone�.. ...................... .. Installation will serve: -Residence partment Houses] Commercial:❑Trailer Court 0 Motel ❑-Other .....:........ =— Number of liv ... 1 ber of be o s --- •--.-..Gar a Grind Lot Size pi�r.1�/ 9r.?{ .: dk - r War Supply:,Public'System and name ....._. � •5 ._ � _.......------_--•--....#.........Private ❑ Character of soil to a depth of 3 feet: Sand❑ . Silt Clay Peat❑ Sandy Loom (3 Clay Loam Hardpan ❑ Adobe Fill Material�� I#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 %vailable within 200 feet,)/ PACKAGE TREATMENT ,1 r-.*_....----- Liquid Depth ........... :..........O [ 7 SEPTiCAN_K e.....: .. Capacity `�` Type Material. ... .............. No. .Compartments .-.- .....- J ,. Distance to nearest; Well .;. '. ...... ..........:.....Foundation - .__` _._--- --- .... Prop. Line .��..... ...... . , S LEACHING LINE . ( ]i IVa. of Lines ------ Length of a line.�r±� � � ---- ------------ .J�_..�._.-----... Total Length ............ Ul D' Box . .. Type Filter Material .. Depth Filter Material --- .. ................... F....:..: Distant0 to nearest: Well ..., - '-� -- ... .�' Foundation�................... Property Line ..s��.:'..-••..•-.- !. ! � �" SEEPAGE PIT (Depth .:_ . ....... Diomet 3-2 .. Number .--.................... Rock Filled Yeb-Gg-- No Q Water Table Depth r .: ................Rock Size A4-X . r Distance to nearest: Well �, :.:............. Foundation /. .C._'�Prop. Lina . ..:.......:_....... REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date .................................. SepticTank (specify Requirements)')---------- --------- -------------------------------------------..................---------------- ......................_................. Disposal Field (Specify Requirements) -------------------------------- --r-=:•-•---..._........_...--------.....---...------ ------------------------------------------------------. -------•--- -----------------•--•-----.....---....._..._.I.......--- -•---._..........._...-----....._..._._.............. -----------------------------------------------------............................................................................................. (Draw existing and required addition on reverse side) I hereby certify that I have prepared i this application and that the work will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquinin focal Health District. Hoene owner or liven. sed agents signature certifies the following: "I certify that in the performance of the work for whick"this permit is issued, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed Owner B -- y •...............•-----_. . :. `L - Title _. (if other n owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------- r.. .......... ----•-••-A••--- -•• - ------------ -•--•-• . --•------•-.... DATE ...�. ... .......... .. BUILDINGPERMIT ISSUED ..........................:.. .:.........----•- ---•• . .................:.........I...................DATE ........................................... ADDITIONALCOMMENTS ..:....:.....•.......... .---------•--•....----•--•-•--........................... ......................_.--•---.................... -------------------------------- ---------- -------------------------------------.._:.........-----------........................................:--.-•--.................. -----------•........... . ... .. ------------------------- --------------- ......._._. ----- ...__._....... ------•---- Final Inspection. . , by: ..... ._. . . ..... ' .. ..............Date �. � ...... ...... ... SAN.,JOAQUIN JOCAL HEALTH DISTRICT r_ w 13 24 1_-GR Rov sAA 7/ 19 -4 u ;