75-505 - Laserfiche WebLink

Home Browse Search

r _ •r FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT .............................._.._...._..._........... Permit No. _~ ..5_!. t3^ I !� (Complete in Triplicate} ........... .... ....................-----......._ 0 7S� -- Date Issued ... .. ......... This Permit Expires 1 Year From bate Issued Application is hereby made to the San Joaquin Local Health District for o 'permit to .construct and install the work herein described. This application'is made in compliance with County Ordinance No. 544 and existing Rules and Regulations: - JOB ADDRESS/LOCATIO .�G. r..3...... ...... .. ----- .. r ..::...................CENSUS TRACY ................. ........ Owner's Name ' ............. .... ......Phone .. a. ......... .. . .. . ... .......... i Address -- - ----------•--- 1-----------•--. City Contractor's Name .. _. ,..rl_-. . �-rid..--.License './�1'.�7. Phone � � �•` Installation will serve: Residence CeApartment House❑ Commercial ❑Trailer Court ❑ Motel ❑Other .......... ----------_------- Number _------Number of living units:..,..... Number of bedrooms -_-%Z......Garbage Grinder . { .. lot Size _.._,�~'�!x �3•®......••• F Water Supply: Public Syste lm and name .... --•-.•-. ^� _..... .. •..........................................Private ❑ 0 Character of soil to a depth�Mof 3 feet: Sand❑ Silt❑ gClay ❑ Peat❑ Sandy Loam El Clay Loam ❑ Hardpan ❑ Cl Adobe Fill Material _..._...- ..... to •-- If yes.hype _............. ........ W I [ (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 perm ,) itted if public sewer is available within 200 feet �I PACKAGE TREATMENT I }F SEPTIC TANK.1 ]"rS e-----.- ------- .................:.......... Liquid Depth ................._._--._.. Calpacity .. .... Type --- Material. ........ No. Compartments ...................... Distance to nearest: Well . ,---- _....------._•----------Foundation ........... .......... Prop. Line ........ ............. LEACHING LINE � ` No. of Lines Length of each line ... / - ../ ,. g ..(�........:...... Total Length ..T--�---.._......_.__. 'D' Box f Type Filter Material --.-Depth Filter Material /_,r. # Distance to nearest: Well -. Foundation ..-- Property line .................. i SEEPAGE PIT Depth Diameter 2,7....... Number ......�........ . ..... stock Filled Yes No 0 I� f e. r Water Table Depth _.. ��(.y ---- -------------------------Rock Size _.:. ..........-----. ....._ Distance to nearest: Well ... ....Foundation --.-lel ... Prop. Line .-_ .......... REPAIR/ADDITION(Prev. Sanitation Permit># ---------- ----------- .............. Date --------------......--------.-----) Septic Tank (Specify Regluirements) ....... .. .....•-- ........ --- ---------------------- -- ---_--_---- ••--- -----_...?VI............................. r Disposal Field (Specify Requirements) ---- A. . . .-- ...... . ........ ........... .. ------ .... t (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work will b* done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local 11,11961111% District. Home owner or licen- sect 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 i ...-.-. Title . .... (If her Chanowner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ._. ... ...... ............................... DATE ..7.. ............. ............ BUILDING PERMIT ISSUED(._.._ ......_:. ........ -. ... DATE :................: ADDITIONALCOMMENTS 0- - -• _.......,:..._.._.. ....... ---------------- --- ........._.------- .,............... ......___.-•-••----................ ...................... .......... -- -------------- ---------- ....... ----------•-• .........---- ---•---........._............---............... ii - . ....-----••--------... ------ ------- ------------ -- -- ..-_---- ...... ............... ------------- .....------.---*-......._h FinalInspection by: __...----�1 ...... . ... . ......... .. ...... ................ ............................__..---------Date ' .--------- -• SAN JOAQUIN LOC HEALTH DISTRICT z 2.3 .KA � li F u 13 241_'AA Rev_ 51u1'f :