74-1034 - Laserfiche WebLink

Home Browse Search

FOP' OFFICE USE: APPLICATION FOR SANITATION PERMIT .............. Permit No. ...7..y.1..... (Complete In Triplicate) ... This Permit Expires f Year from Dat*Issued Date Issued�/:/3-.•7 a 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 Ordina ce No, 549 and existing Rules and Regulations: j JOB ADDRESSAOCATION .....1. +-, IFW.S.0+r1�. .... — ...........CENSUS TRACT a .... .......................... Owner's Name ....17�. '-./T �. .......... ......................... ............................... . ..........-........Phone .................................... i Address _45� ,•S7 . . .... 1��4f/ -.J�i1U�-. City ,Tie�C1i its..^".... Contractor's Nome .. _ ,�-z [ =0r_t=_ .., ........_License Installation will serve: Residence Housefl Commercial OTraller Court 0 MotelQ Other ............................................ Number of living units...../..... Number of,Iydrooms ...........Gar age Grinder ............ Lot Size _1_P.XMXD.................. Water Supply: Public System and name Character of soil to a depth of 3 feet: Sand r] Silt❑ Clay ❑ Peat❑ Sandy Loam 0. Clay Loam ❑ Hardpan ❑ Adobe.Q Fill Material ............ If �type a ............... ............ 0 Y (Plot pian, 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---.,.��_•___.._•.................... Liquid Depth ...�,5............. Capacity _12&co....... Type 'x6r4leWs Material...................... No. Compartments ....Z! r Distance to nearest: Well --- ..............Foundation ........ Prop. Line ..:91 .......... LEACHING LINENo. r ] No. of Lines .......Z......•-r-.....--- Length of each 1in�...�--=-�f.�--.------ Total length ................. 'D' Box 6>,,2- Type .Filter Material _Ic. ..Depth Filter Material ...,/ -E............. Distance to nearest: Well -. ... Foundation _/0............. Property Line ��~�............... r SEEPAGE PIT [ ] Depth .�,.!��--•---- Diameter -:72 .... Number ...../. ................ Rock Fir �iVo ed Yes 0 1% Water Table Depth _.. --•••-••---•--.....Rock Size .,2: .... Distance to nearest: Well .. ---------__--- -Foundation _._./40........ Prop. Line ...................... REPAIR IkODITION(Prev. Sanitation Permit# ...........................................- Date ............-.....................) Septic Tank {Specify Requirements) ..................... Disposal Field (Specify Requirements) •-•--- ........----------------•-----.................................... .... --•---------....................... ................ ' ............... -- --- i .. ----- ----• ----------------------------------------- -............................................................................ (Draw existing and required addition on reverse side) 1 hereby certify that I have prepared 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 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 beco,Pra blect to Wotkman's C pensation laws of California." Signed --- --- - --- ---------------- ..............._--- Owner By ------- - - ----------- ----- - -------- - ••--------- Title - .. other than owner} FOPDEPARTMENk USE ONLY APPLICATION ACCEPTED BY -... DATE .. ~l - 7 BUILDING PERMIT ISSUED ........... .........•---------------• ---_-.DATE ...........................-...... ADDITIONAL COMMENTS ......---------• _-... ....................................... ---44�__V --..---.---..-.. ---------------------------------------------------- ----- -..... .--. .--. . . --- ... ... ........ - - r Final Inspection by: -EH �� 2� �� Date SAN ... .. .....- Rev. JOAQUIN L L HEALTH DISTRICT 8711 3M - .