76-910 - Laserfiche WebLink

Home Browse Search

i FOR OFFICE lJS[:: • APPLICATION FOR SANITATION PERMIT _111.1....---•. ................................. . .......!�b... (Complete in Triplicate) Permit No. -11...11............1111. ................. �C 7� Date Issued __.. This Permit Expires 1 Year From 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 aunty Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION 5'� .... . �................ -- .~ . ..._-- ----.--..CENSUS TRACT ......_..........:.__...._ Owner's Name _,. 1.= --------- ----- .................:._.._ c. .~Phone 1111. ... ...................... ' 1 ✓ -u- ct Address .... . _. - _.:_ Contractor-s Name `' J� "'� --- =.License # .1.. g.3 yPhone ......................... --i- Installation will serve:. Residence.Cl-A--partment House[] Comrn�ercial ❑Trailer Court ❑ Motel F1 Other ..:. ` .......................... . J.. 0..... g ?.tW Number of living unrtsc.....- _... Number of bedroo lot Size..................:.P r 9 -.._ .Private Water Supply: Public System and name .__1:11.1..:_-.--ms.^_'.....---• Gar-a.-•e"..Grinder................................. ....... [q— l Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat 0 Sandy Loam Clay Loam❑ t ILA: � Hardpan Adobe Fill Material If,yes; type -- ------------ (Plot ----• :_ -(Plot plan, showing size of lot, ,location of system .in.relation to wells, buildings, :etc.i.must be -placed on reverse,side.) NEW INSTALLATION: (No septic tonk or seepa e. pit permitted. if:public sewer is availa6le'witl in 200 feet,): 1111 �� ...... Liquid Liquid .Depth .........:.............�..- PACKAGE TREATMENT ) ] SEPTIC TANK: � Sizer-.!.�.�--�-...'�. � � `'Z Capacity Type - Material._ — : No: Compartments ....... - / , s Distance to nearest: Well" . ..............Foundation Y--~~�<�3---_11 11_ Prop. Line ----s ........... LEACHING LINE f No. of Lines 3 length of each line ..`...._7!a .:�.-.., Total Length _.. -_ .0..�._....:. "D' Box : �' .'. Type Filter: Material r "1�:.='.Depth Filter Material ;.._....�.�7.'_.� Distance to nearest:Well Foundation Property Line .:...... ..... SEEPAGE PIT Depth .. .;.. =-__ Diameter =---=------------- Number 1'::111- .--. ±.._...;_,_� Rock Filled Yes ❑ No Q Water :Table Depth _...........: -----... ---------------------Rock Size ------. i._... t.. - �f f Distance to,nearest: Well __ ....._ .............................. Foundation :-- :. ._ Prop. Line; .......... REPAIR/ADDITION(Prev. Sanitation'Per..mi1t11#, 14............... .. __..- 11__ Date ------1.1 , --- Septic '. Tank (Specify.Req:uirernenis) ............-...11--------------------------------- ------• •--.:...... ------ ....... Disposal (Specify Requirements}Field {S Fiepe .: = ---------111.1_.. -- .w. pe ----------------- ----- ..---..........__.......1 -------- ...................... 1__111 ..............11 ... ..........------ . ............. ----:--- - ------------ ............... ................................. ....... (Draw existing and required addition on.reverse 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 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 nee, t ' ByB ../� . .._ ._:`: .�.`'111,1.. ,.- Title . .... .. ..� 1111 1111 ..................... .-1111 . . . . ........... ... ..� -- ......_........ .. 1111 r (If other than owner) FOR EPARTMENT USE ONLY APPLICATION ACCEPTED BY . ...... DATE ..... C}: .-� .... BUILDING PERMIT ISSUED --------- ........-............ ------- ........DATE .. ....................:.____._.......... .. ADDITIONAL COMMENTS ................................. .......... •---....------..... --.._-.-.------ --. --------•---... ..:........... . • -------------------- -----..- ---2-.J..-26 .. --................. _ _1.111. .. Final Inspection by: ................ :. .. .2 ..._ .--.--------._...D t .. .f` �-26----:------__--- d•«-- SAN JOAQUIN LOCAL HEALTH DISTRICT 7/72 3 M