76-1048 - Laserfiche WebLink

Home Browse Search

rv� vrr�t.z L75E: _ - APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permi'No. ................................................. . This Permit Expires t 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: JOB ADDRESS/LOCATION ......................................Mak 5Cpow/.¢rz,L .9A/IVR,, , �E�o�jl CENSUS TRACT Owner's Name ----. .... A.ISIC__.. �C��17�_�'.�. ��..............• ..Phone 9 Address . . .- ... .... ............................. CityFtE.A(C#.C' r�.p ? .................' p--........---- Contractor's Name ._ r../�.,. .e:.�_i �` T[tCX-,TqV-- ..... _... Phone ..License # ...... ............ 66 6 . - .._....-1.�..._Q�---... Installation will serve: Residence Apartment House{] Commercial ❑Tra€ler Court Motel []Other Number of living units:-..kNumber of bedrooms ...... Grinder ............ Lot Size . � Water Supply; Public System and name ..... Private ❑ Character of soil to a depth of 3 feat: Sand El Silt❑ Clay p Peat❑ Sandy Loam fl Clay Loam Sr Hardpan ❑ Adobe 0Fill Mpterlal ............ 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,) PACKAGE TREATMENT j ] SEPTIC TANK { Size._..�...?� .......................•--- Liquid Depth Capacity _2 0 0------- Type .._res'.-('sr-•Mater€alsarr _._ No. Compartments ...i?r............... Distance to nearest: Well PQ_v_UA- ------------- ------Foundation ..../.4�...:..�.. Prop. Line ..../.. LEACHING LINE No. of Lines -___.•- ._.._-__.-_ Length of each Ane..106 ` Total Length ..... 0.Q_...I....... 'D' Box ..._t..-._• Type Filter Material-_ _•.Depth Filter Material f �r Distance to nearest: Well 140-f4rT........ Foundation ..../.0-'.. ........ Property line ... --_ .- SEEPAGE PIT Depth - _ ... ... Diameter �_ _..-__ Number ... ..--`-� .... Rock Filled Yes P( No i❑ Water Table Depth ,/469 e .. / -----------------------------Rock Size ._..:. .._-- -1/ Distance to nearest: Weft ...PLqOZZ............... . . Foundation ....... Prop. Line ....... .._ ._. REPAIR/ADDITION Prev. Sanitation Permit;# ------- Dafe --.....-•--•----••----- Septic Tank (Specify Requirements) •.................................... . Disposal Field (Specify Requirements) -•------ --------- ------------ •---------- -----------•----- ---r---•----- .-� ... ;.....---__•............... r (Draw existing and requiredaddition on reverse side) - I hereby certify that I have prepared j 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 Joaquln Local Health,District. Home owner pr Ilten- sed 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 Imanner as to become su lett rkman's Compensat* laws-of California... Signed _ t �°p BY ----- ------ -----------•--------••---------• ----- -- ---- -•----• Jitfe (if other than owner) --•--�-•- FOR DEPARTM SE LY APPLICATION ACCEPTED BY ...... - ------. DATE ...1.�.-(`7-7(�_......_.-....._._ BUILDING PERMIT ISSUED ......................... . ••--- ----•---- ... ---•-- -----------------DATE _..-_._. .............. ADDITIONAL COMMENTS ---------•_-......... •-••------- Fi l ins on b ---------••-...... ............. •-•-----.......-._..--. Final Ins ection b - - EHY -_----------------------------------------------•-...............-..-._._._. .- -_ ......��-_- ....Date _..c5-5.-77------ ..................... 13 1-�f3v' SAN JOAQUIN LOCAL HEALTH D RICT 8/7!I 3M