73-466 - Laserfiche WebLink

Home Browse Search

f FOR OFFICE USE- ------------------ SE- APPLICATION FOR S4NITATION PERMIT - - --------------�.,..3.�....._....- Permit No. ..�'�..`�.�To (Comprrete in Triplicate) ......................................... Y ..................... This Permit Expires I Year From Date Issued 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 made in compliance with County Ordinance No. 549 and existing Rules and Regulations: oak Ln`. , ` J48 ADDRESS/LOCATION .....��.39-� -' •�• CENSUS TRACT .:___._•.................. Harnar�c€a Phone Owner's Name ........................�-------:-...---..............-•--•---------._...................--...------------�-----..........._._ ............__... .. ...... ...---- MS Address -_sane--•................ _. ,..... ......_.__._............----... ..................... City ..........-•----...... ka....... .?. a Blacka?^ds -Se tic Tank License # 268.41..... PhondFb3o. 01.�$....... , ^ Contractor's Name ..................................••-- ------......---------.....-•--•-•t-----•----• --- ... �4 4 Installation will serve: Residence CJApartm ne t House 0 Commercial ❑Trailer Court 0 Motel ❑Other - ' Number of living units1-__..__..._ Number of bedrooms ___3......Garbage Grinder ....`` Lot-Size ._al... ................ �P vote � Water Supply: Public System and name --------------Z,=XXm__...........----•--•-------------------------.-------...................------ � i CLocter of soil to a depth of 3 feet: Sand D L Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam--M, f # Hardpan ❑ Adobe 0 Fill Material ------------ If yes, type ...................... -.... (Plot plan, showing size of lot, location of. system in relation to wells, buildings, etc. must be placed on reverse side.} NEW INSTALLATION: {No septic tank or seepage pit permitted if public sewer is available within 200 feet,) ` �J PACKAGE TREATMENT [ ] SEPTIC TANK [ ] Size................................................ Liquid Depth _ '`--- ---:............ .� q Capacity .................... Type --•----------------- Material.---•-----...- No. Compartments ----• .................•..._. ._ Distance to nearest: Well _______________Foundation ...................... Prop. line.................... LEACHING LINE [x] No. of Lines ______________1____._. Length of each line._.._ .$.Q_±----_-_.__._.. Total Length .... '............ D' Box -.1....... Type Filter Material ......... !t Depth Filter Material " ``. ` Distance to nearest: Well ..... -- -__ Foundation 5A'--------------_ Property Line ��.�---._-_.------. S EPAGE PIT Depth -2- '•==W_- Diameter-.::._:::.:..: umber.__:::..:::- Rock Filled Yes M. No T1 p 2�--- . `" Water Table Depth --90M----------------------------Rock Size ............... I I Distance to nearest: Well _-__.___..1QD-t.........•----.....Foundation _..6�!i.._....... Prop. Line ......�°k: . i # REPAIR/ DITTO (Prev. Sanitation Permit ...'............................. Date .•-- .............._�.-...... �Qtic Tank (Specify!Requirements) .................. r I ::—.—J...... 's.. __......��....................... Disposal' Field {Specify Requirements} BQ-!_..LH--Lin-e p �}8'' f2.,r�►.....--•• + '�" .....................--•-............=... ---------.............-------•-•-----------------.............-•-------------------------------------- ----------- ........... ------=--••----- '�i I I .............. -- ---------------------------•. --- . -------------------------------•-•--• - -- (Draw existing and required addition on reverse side) f I hereby certify that I ,have prepared this application and that the work will be done in accordance with San Jacquin« County Ordinances, Sta a Laws,and_Rulis and-Regulationstof the San Joaquin Loyal Health District. Home,owner or liven. sell agents signature certifies the following: "I;certify that in the performance of the work for which 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 ( r By Title contractor.................. ; (If other than owner) s.E u ( i FOR DEPARTMENT USE'JONLY j 1 APPLICATION ACCEPTED BY ..... ........ . .. ._._..... --------------------------------f DATE ...._._ ..7. 2_ 1........._ i BUILDING PERMIT ISSUED DATE ADDITIONAL COMMENTS ........... . ..... :4--------------------------------------------- -•----• -----------••-------••-------.ll _.......- ----•-{ -----------+....._.. ................ ,, - - ..........................:...............................{-•-• -•-----•---......._.............. .. ..: ................ ... .. --- ---•-F---•---------------- Final Inspection by- ---:.. ... .. i Date r�f� ---------- .. _ . . SAN:JOAQUIN LOCAL HEALTH DISTRICT i R 9A . .,.. 7/77 3 M