74-140 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE F APPLICATION FOR SANITATION PERMIT -------=------------4 / (Complete in Triplicate) Permit No. -_-_�'`�-`1z,1-0. ---------=-------------------------------- - This Permit Expires ] Year from Date Issued te Issued _ � Da � _�. _. i Application is hereby mad 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 grid'Regufations. JOB ADDRESS/LOCATION :. 2-3 9--RQ_o-sevelt----------------------------------------------- --------CENSUS TRACT ------------'-- ---------- Owne'r's ----• .Owner's Name -----XrS_�I!4-- tame ---------------------,------------------------------------------ -------Phone ------------------------ - Address " -------------1-27-j---1 s� '1©Q City �S t�- Contractor's Name _ aC �S'Si'S___�Set�-tic---Trek----------------------------License # ---26Phone --_ b .- 0' ------ Installation will serve: Residence t] Apartment House❑ Commercial :❑Trailer Court i❑ Motel ❑Other ------------------------------------------ " Number ofi living units:_____-1__'-> Number of bedrooms _],;________Garbage Grinder _____.____._ Lot Size ______ X a-_________________ :IM Ci ty Private ❑ Water Supply: Public System and name --"----------------------------------------------------------------------------------- Character of soil to a depth`'of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑` Sandy Loam '❑ Clay Loam ❑ Hardpan ❑ Adobe.a] Fill Material ---- ------- If yes,type ____________________________ (Plot plan, showing size oI 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 --------------------------- Capacity -------- Type -------------------- Material--- }--- ----------- No. Compartments ----- .I 4 • ' Distance to nearest: Well {_________________Foundation ---------------------- Prop. Line�O_____, ---------- 6 LEACHING LINE No. of gof each lineal Length F o DType Filter Material Depth Filter Material I�. aDisl�ance to n crest;1Nelt ______-- " -- Foundation .--_--- Q------_----- Property Line ----5'----!----_----� ((r SEEPAGE PIT ] Depth ----- ------ - -- Diameter ------- 3 -- Number ---------.-1-------------- Rock Filled Yes R] No C] Water Table De th _____.__'_ e _ ________Rock,Size -__2--________ ' Dislt�ance to nearest: Well ---------------"-"'-._----------.:Foundation --------50 Prop. Line -----------:F---9---5f* REPAIR/ADDITION(Prev. Sanitation Permit# --------#------------------------------------ Date ___.___._______.._..__.._.........) Septic Tank (Specify Requirements) .. - -------------------------------------------------------------y---------- ''' Dis osal Field (Specify Requirements) - aCh__ ,2. �_-s1 Pit ------- ----------- -------- p I P y M q 3-3 .X2 k --------------------------------------------i----------------------------- ----------------------------- '- - s (Draw existing and required addition on revere side) I 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 JoaquinLocalHealth District. Home owner or liven- 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 By Title ------ __ f - (If other than owner) TMENT USE ONLY-- APPLICATION ACCEPTED' BY DATE ---------------- " --------------------------------------------- ;I BUILDING PERMIT ISSU1 D _�_____ . -- - --------------- - -_ DATE ----•---- ---- --- . -- --- -- i f ADDITIONAL COMMENTS'-" ------------- -- --�_-•- ----------------------------------------------------- ----- - 'F - --- ----------- --------- IF r ' - n - on-b-------- -- ------------------------------------=--------------- ---------- - -- ------------------------------- 1 FinalInspection by- - -- - --------------------------------1--"--------------------------------------------------------Date _ SAN JOAQUIN LOCAL HEALTH DISTRICT ' SM E. H:-,.9 1-'68 Rev.