72-1042 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR 'SANITATION PERMIT -------------------- ----------- - j Permit No: --------------- ----��-- n3 y 'Complete - ------ ---- _ ---------------- �. ..."� ,T. �.. -_ _ ..._ �. : _.. _. --'a ""'""' Date 1 ssiied --.° - ----------------------- This Permit Expires 1 Year From 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 mads in compliance with County Ordinance N9,549 and existing Rules and Regulations: { JOB ADDRESS/LOCATION -------36-3--S01,--Patrick-_Bd---------------------------------------------------CENSUS TRACT --------------.------•---- � 462-326.4 Owner's Name Edns Saselli - -------------- -------Phone ------ -- ------ -•----- ----------------------------------------------- } I -----•------------------------------------------------- City --- S Iq--------- --------------------------- Address ._SaI17.�--- - ------------------ - -------------.....--•-- Blackard! s Septic Tank Co. License # 26-8-9-51-------- Phone ___46_3y-7Q48--___- Contractor's Name - - -- ----------------------- Installation will serve: Residence 0 Apartment House❑ Commercial'❑T�ailer Court'l❑ • Number � Motel ❑ Other ------- -------------------- ----------- f 1 acre of living units:----- ----- Number of bedrooms - 2___.Garbage Grinder ------------ Lot Size -_-_-_____________________.___._--------. Water Supply: Public System and name ------------------------------------"------------------------ ---------•-- y Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ .Peat❑ Sandy Loam "❑ Clay Loam ❑ Hardpan ❑ Adobes] Fill Material .;--_______. 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 11tankor seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK,Dq Y Size______ 'X5_'X1.Q__'_____________ I Liquid Depth ----------- 8----__----- W ' _._. Capacity 41200------- Type ---sq- ---------- Material__-conrr-ete.1No. sCompartments ------ � 2 Distance to nearest: Well ------------:W-7A. __Foundation -__.�fl---______ Prop. Line ___ �............. LEACHING LINE [M No. of Lines _1-------------------- Length of each line ---- Q ---------- Total Length 10-1-------- ---------- D' Box Type Filter Materia[ ____2;!_,_`._.-,----Depth .Filter Material __19" ____________________________ 1 yP Distance to .nearest: Well ._=__ _ _� Foundation �----'�------- ---- Property Line. ---_--��-�..--------- 1 ;.� '� SEEPAGE PIT [ Depth -2- -'------------- Diameter ..O b'_,_ Nurriber -----------1.--------------- Rock Filled Yes :] ;No "i❑ 211 i Water Table Depth ---------------- - ->Rock Size ------------------•-•---- ' Distance to nearest: We]I ___.-----------10-------------�-=•---Fouundation 5�- -------- Prop. Line --------•------------- 1 REPAIR/ADDITION(Prev—Sanitation Permit# --------------------------------------- --`Dat ------=------------.--------------1 Septic Tank (Specify Requirements) --------------------- 1-2-©0---gal- SEpt-�:G--Tank---•-------------------------"-------------------- = Disposal Field {Specify Requirements) -----1� 0'___ CaC• 1_Lne_-&_-_36"-X25'---Pit. _-----___ [ �I t: ------------------------------------------ - ----------- -------------------` -- -------------- --------------------------------____----____-___----_____________I---______--________--•_---_______----_______-___�_.-_______.-------------------------------- --- _________._---___________-_____ .� p pfl (Draw existing and required addition on reverse side)'. I herebycertifythat 1 have re cred this application and that the work will be,done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the. Scn 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, 1 shalsl not employ any person in such manner as to ecome subject to Workman.'; Compensation+laws of California." . Sig ___--_' Owner '" Title By --...R:; B-i11 B1, ck�arjd---- c-ontractor i (if other than owner). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY ------ --------------------------------------------------- ------------------- DATE -- --------- --------- BUILDING PERMIT ISSUED ----- ------ -- ----- ------- -------------=--------------DATE ------------------------------- ----------- ADDITIONAL COMMENTS ------------ ---- -------------------------------------------------------- -------------------------- --------------- -------------- ------------------------------ -------------------------------- ---------- E - ----- ----- - �Al -------------------------------------------------------------------- ---------- /// / Final,.lnspection by: --- ----------------•---_-- _ -- to _ -/- ' AQUIN LOCAL HEALTH DISTRICT G E. H. 9 1-'68 Rev. 5M