76-103 - Laserfiche WebLink

Home Browse Search

yi;ire,�w yam,`.•.1.Mr-�T it FOR OFFICE - SE` APPLICATION FOR SANITATION PERMIT ......... . ..... .... t�`i Permit No. .--- m SCople in Triplicate) Date issued .................... -••••----•----•-••••,-.--_--.--.• • '•---------•--••••-- This Permit Expires i Year From Dale Issued / y/�V{ , • 1 F • i.1 Y • 011- ( i.1 _// 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 ry compliance with County Ordinance No. 549 and existing Rules and Regulations: #Z23 q , Al- �� Lodi :on..Ra;�_R�.. � ...�. 1�5U�I_ ................. JOB ADDRESS LOCATION �itd,.X1olLsa.- •_ 6�3 �._,._._,. _,..._.. _ ...•... . ... . w.�. Tom Rea o of ......................... Owner's Name : ..........................•-•••--... ;r Address _.Same as above = City .....................:.: - ...._.. .............. ._. Contractor's Name G'-_&..-C`..,�egt.3.C...Ta k-..5ex-_----•_•----___=:_'._.:.:.. ---:License # 30n57•-21' - Phone 368.-3933......... Installation will serve: Residence [n Apartment House Commercial ❑Trailer Court i❑ it oy �.' 10 acresr� Number of living units:............ Numberof bedrooms �'2:......Garba e, Grinder. ._. _._.__-.. Lot Size ..._._..____.....-__.:___•••••-•------••-•• ! _.__•_•_.__.__..-_ � .` - ------..... , _Private' s Water Supply: Public System and name --------_----------'• • - f` . Character of soil to a depth of 3 feet: Sand [] Silt❑ Clay [3 Peat C] , ,Sandy Loam ( Clay Loam ❑ _ �. '� I Hardpan Adobe.[3 Fill Material .. if Yes,type -- ---------•_- T. _ Plot Ian, showing size of lot, location of system .in, relation to we lls,'buildings,--etc::must be placed"on reverse side.) W .10 NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within-200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK i Siae: .°�._5_t___.:b,Y_10'.--.by--6-�.•L�quid 'Depth . ;................•--- - — 1 Re-c t.. - . - . – .. .. f Capacity ---:.,6OQ_..Ga1)Ppe .+t-"ttt'"Material_. iAA,DY'ir. � No. Compartments Distance to nearest: Well _50...................... __Foundation 3 �•__......._ Pr p. a .,..JP-.; ......... - t 4 .. o Lin . ._ _ Q LEACHING LINE [ ] No. of Lines -_--2__:-••�-=-'� Length ofeach line..---i�Q------------------ Total Length� Q...---• , '- _ _D_. . '�`Material '�1 . 'D Sax'l?!:_ Tyke Filter Material _1lsr--_-. epth Filter ;= ..................... . D stance to nearest: �elCp.............. Foundation7Q� --- '....----- Property. Line :. `5s.....__._...._. -t - I SEEPAGE PIT Depth 12�._ _ 'DW hbr •- -.Number .--:-�::.................:: Rock' Filled Yes � No !D t Water Table Depths.._9Q.,,...----..............................dock Size• _. ...DY-21i------------- Distance to nearest: Well _17.4..�:.-&__-IN t____-.--...Foundatiol OQ--=s:....---+�-. Prop. 'Line 15................ REPAIR/ADDITION(Prev. Sanitation Permit!#` ....................... Date .................................. Septic Tank {Specify'Requirements) • .........................................---------.........._.__...------•-------•-----.-.-_---- Disposal Field (Specify Requirements) ------- - -- ...................................................................................• - •--•-•. ----•............................ .................................. -- (Draw existing and required addition on reverse side) I hereby certifythat I have prepared this application,and .that the work will.be done in accordance .with San Joaquin.. .- { County Ordinances, State Laws, and Rules Arid'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 become subject to Workman's Compensation laws of California." Signed _- --- - ...). __.- _.:..- - •---. ••............. -. Owner ` oe ... Title...:...... ...------•..:other than owner Q .� -r._- ._$s.._�i` : ii_R ..C:._2' -.-►tsar'.. FO DEPARTMENT USE ONLY 3 APPLICATION ACCEPTED BY .... ................................................ DATE .._....�.---- --• ----...... BUILDING PERMIT ISSUED _........--- DATE ...... :....... : ADDITIONAL COMMENTS ................................................................. ................................................:................... ........ -•-----------------------=------- •............---•........................•••-••.................................... f e "' Final Inspection by: = Dat ... ------------••-•--- .;.. . . ..---•- SAN JOAQUIN LOCAL HEALTH DISTRICT