75-188 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE- .- ,-. � APIPLICATION FOR .SANITATION PERMIT ...........".................. ...............•-•-- -- F (Complsto In Triplicate) Perm . ......... ... .. ... Permit No �-S M ... [ This Permit Expires 3 Year Frain Dots issued 13die f sued :%1-.75� described. is hereby made to thellSon Joaquin Local-Heolth District for a permit to construct and install the work herein e cribed. This application is made in,compliance with County Ordinance No. 549 and existing Rules and (Regulations, JOB ADDRESS/LOCATION. ff [(-` I -- . ....l......,.m1.- �� -�- �...P>�!...................CENSUS TRACT Owner's Namet- .. ..U.- . ..I_.r4 -. ._ ...r...... u..W.......................Phone .-.................................. Address _. _ .-... ..- )� i � . '.-/ / .......•..... . . ......................... Contractor's Name r...... ----••-----_ •-----=--------License *UM5- _ Phone Installation will serve: Residence Apartment House❑ Commercial OT- roller Court 0 Motel ❑Other------------------ Number of living units:............ Number of bedrooms ... ....Garbage Grinder ------------ lot Size .._.••....._ Water Supply:-Public System and name ...._._. Private ..........-••••----....._..._..•_....•----- . .-----------------•......-----........ ...._P i ate[� Character of soil to a depth of 3 feet: Sand 0 Silt 0 Clay ❑ Peat❑ Sandy Loam 0 Clay Loam ID- Hardpan 0 ' Adobe 0 Fill Material -------- ... if yes,type ...... ......... (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed an reverse side.j , NEW INSTALLATION: (No septic 4onk or seepage pit permitted If public sewer is available within 200 feet,) PACKAGE TREATMENT ( ] SE PTiC TANK I ] Size........:........ .. Liquid Depth _..___....__.__._._..,..,.; 3.. ._.- Capacity -f!- 3--- Type �rYCX'.T. . Material l--�'�>��r No: Compartments Distance to .necjrest: Well .....�i� ....._......Founda#ion �_ CkG 7 -rop. Line f f Q -i �1 r�th LEACHING LINE ( j No. of lines ........ .::s Length of each tin t...--._ .o a �.Le _... 'D' Box .. .. Type Filter Mated Material-_ g................•----------------- Distance to nearest: Well -•-,��--- ......... Foundation ........................ Property Line ........................ SEEPAGE PIT" J ) Depth <7It............. Diameter --- ...I...... Number ........I.................... Rock Filled Y s 0.-:_ NO-0 Water.Tabie Depth .................................... Rock Size . < Distance to,nearest: Weft ................. ......................Foundation ................. Prop.- Line ........ ------- REPAIR/ADDITIONrev Sanitation.Permit d` . Date :...........:.......... Septic Td-nk (Specify Requirements) .....................:. .._._. - -•-......---.........--•••---........._._.__....•----........._.........-•-•-•---------........... Disposal Field (Specify Requirements) ......................... --•---•------------------•-----------------•------- ,� -- (Drow existing and required addition on reverse side) I hereby certify,•thaf I have prepared this application and that the work will be done in accordance with Son Joaquin County Ordinances, State Lags, and Rules and (Regulations of the San Joaquin Local Health District. Homo owner or licen• sed agents'-signature certifies the fpllowing: "1 certify that in a performance of the work for which this ,permit is Issued, .I shall not employ any person in such manner as to beeoine su ect Work 's m satian laws of California." Signed ------- --_- Owner � y = .... . ..................... Title ... - ..� I (If other the owner) d FO DEP RTMENT USE ONLY APPLICATION ACCEPTED 6Y ---- --•••- -------- DATE... ._ - ------- BUILDING PERMIT ISSUED -- - ------ ------------------*-----------------------...DATE ADDITIONAL COMMENTS • ----- ------------- ----------- ----------•--•---.......----•--•---.-.....--........--------.-•----.._........-........................ ----------------•------------• _ ................................-•----- -.--- -- ' ---- ----.---------....._ ...----..._......._..........-. .-.... -------- ................... ........... •. .. ........... .......... ......... •- . .. Final Inspection by. ..--•............. ... .. . .----1-.. - , ....--- •-- .-.......- ;: .-..'__.. ..............::..-Date ....-•-.��..�--- -� EH 13 2h 1-68 IL-v. 5h � _ �...; SAN JOAQUIN I XAL H ALTH DISTRICT 8/7hp 33''1