75-104 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE- APPLICATION FOR SANITATION PERMIT 3 Permit No. ...7 5..:�U!� ;Complete In Triplicate) .. ......................................................... This Permit Expires 1 Year From Dote Issued ry.. 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/i.00AON .._. iFi _../ .........................CENSUS TRACT ...... ................. Owner's Name _... : aara ....C....14-r-f.�Ql ...............Phone ..... ----•... ................... ---• Address .._...... .._ C, ... �a��9CC7f1.r✓f..... 1 ,��. ¢ -�i _....7E �....:. Contractor's Name .. Fit..ii. Phone � -d� Installation will serve: ResidenceApartment House Commercial❑Trailer Court Motel ❑Other............................. ........... Number of living units•___.! Number of bedrooms _.��. ar Gbage Grinder ...-........ Lot Size ............................................ t . Water Supply: Public System and name ----------- ��......r,L P- -------------•...........................................Pr€vate ❑ Character of soil to a depth of 3 feet: Sand o. Silt O Gay ❑ Peot❑, Sandy Loam ❑. Clay Loam [] ` Hardpan ❑ Adobe 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 ovailable'within 200 feet,) PACKAGE TREATMENT I ] SEPTIC TANK f ] Size..................................... Liquid Depth .............._..._ ...... capacity Type •--••............... Material....................._ No. Compartments ................... Di stance. to nearest: Well ...Foundation Prop. Line _ LEACHING LINE ] No. of lines ------------------------ Length of each line----------- ................. Total length ............................�},t 'D' Boit ............ Type Filter Material ....................Depth Filter Materia) I "�` ' ✓ Distance to nearest: Well ..................... .. Foundation ........................ Property Line •' SEEPAGE PIT [ ) Depth __:_... Diameter _ .___. Number --------/................ Rock Fit ad Yea No i](o i '1 Water Table Depth ............ ......................Rock Size ----.�.�!'�•�� . s Distance to nearest: Well ..............Foundation .f ........ Prop Line .. .... . A REPAIR/ADDITION(Prev. Sanitation Permit ` .......______________ .. Date ) Septic Tank (Specify Requirementsl.------------- ------------.._.........................................,.................. ...... ... ....... Disposal Field {Specify Requirements). .. ........ 2::�_..:-.__. _/ �. / _ . .........� el � W -------------------- -----------------------------------------••---••-----..._-..-.... -------- ------------------------------------------------------------------------------- .............. f (Draw existing and required addition on reverse sidel I hereby certify that I have prepared this application and that the work will be done In accordance with San Joaquin County Ordinances, State Law's, and Rules and Regulations of the San Joaquin local Health:Distrlct. Home owner or licen- sed agents signature eertif€es the following: ' "I certify that In the performance of the work far'which this permit Is Issued, I shall not employ any person In such manner as to becomeu sect t W rkenan' ompenseition laws of California." Signed Owner BY ---------- ............... ............ Title _..- R (If other an ner) F R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY J_-- :------ ....._.... DATE Z. ._Z.y._�., -------_------------ BUILDING - ---------------- BUILDING PERMIT ISSUED -.. - x DATE --- ----- ---------------------.. ......... .-_.-------•--- -------- --------------- ------ -------- -- ADDITIONALCOMMENTS ----------------------------_..._..--------•--- . ---•--........---•--. -...---...-----•-•-----...--•----------...._...---_...------I......I......._._..... .............:. ................ .......... ------ .._._.__. fi ____ _______________ _ _._.___..___._f,__....__..-___.-___---I _.._..........._...-.....-....._.......___ _____.._.._.. _._. final Ins ection b - ________ ______ __ i }} p Y= • --• -- - � �r--?-_-- �---------------------------------�-•-----•-------•-Date �.. .-�.`'/ �-J- ------._...-... EH 13 24 1-68 ► 5M SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3M i