77-58 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE. ...........................•-•:111.1. . APPLICATION FOR SANITATION PERMIT Permit No. 11.11 iComplete in Triplicate) .._._....-.._._1111 ..........I.................................••-••--•-• - _ ? Date Issued 'ia2JK.2..2 This Permit Expires 1 Year From Date Issued "" Application is hdreby 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 Mules and Regulations: �29Y JOB ADDRESS/LOCATION ..s fdnl�2 Qac -..�. 1A�...3v1� �a� cI.,st1u�.�----u1es ........CENSUS TRACT .......................... Owner's Name Wi-D..... Q�_/�U-��s........... .............. ...................:........................Phone .y�aS Y.�.� Address ---w. ....... `5,--- f4 .fie -• 1111 Cf cc4�fd - . .................1111-- Contractor's Name %T- ------------------------------------------------ _---_-----•License ............... Phone ....................... Installation will serve: Residence Q Apartment House 0 Commercial QTrailer.l ,o Motel Q Other...-....../----•--•••••--------------....---•-- Number of living units:-.._1----- Number of bedrooms ....1......Garbage Grinder ............ Lot Size .!/. ..._...... ...............•... Water Supply: Public System and name ........................................................ _ .....:....... •- 1111.....-_...Private, . Character of soil to a depth of 3 feet: Sand Q Silt o Clay 0 Peat E] Sandy Loam-Q Gay Loam Hardpan d Adobe Q Fill Material ............ If yes,type............... ......1111.. (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 available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TAMC ] Size.l . :.. `.:.t.. .................... Liquid. Depth 1111- ............(S' ' Capacity ./A_VP------- Type Material..e&X .-------- No. Compartments ...a?. ............}J Distance to nearest: Well __..,fL&D:....................Fouundation 2- ................ Prop. Line ... ............� LEACHING LINE ,[� No. of Lines --., ... ....-. Length of each line..t;10. ............ Total Length -o'�L................... V Box -------- .:. Type Filter Material ____________________Depth Filter Material ........................__................ -- Distance to; crest: Well .......................... Foundation ..............I......... Property Line 1.111..........-........ SEEPAGE PIT [ ) Depth .................... Diameter Number .............-._.._._------- Rock Filled Yes Q No (] WaterTable Depth ...................................--•...........Rock Size ............................. Distance to nearest: Well .........................................Foundation ........ Prop. line REPAIR/ADDITION(Prev. Sanitation Permit# - . Date ----------------_---------- ) .............----------•---------1111.111.1 ...... Septic Tank (Specify Requirements) ...-•••-•...............:.........•---. :. ................:--..........................._._..........._............... . DisposalField (Specify Requirements) -----•--•---------------•---------------._........................................_.................................................. ----------------------------------•-..............._............................................................................................................ -- ----------------------- ------ ------•-------------- ----------------------.............I...... ......................................... ................. (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:Dlstrict. Home owner or licen- sed agents signature certifies the following: + "1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner i as to becomes ject to W kman's Compensation Taws of California." Signed _.� �`' ---- --lam` ---------- ---------------1-11.111.11.---- Owner By ......... •------------ - ---11 ------..-..-_--- •--- Jitle ._...-- --------------------- - 1111---...--------1111-1111.- -------------1111._ (If other than owner} FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY : ... -- - ..............•...........-----------------111.. -----•------ DATE. �— BUILDINGPERMIT ISSUED --•----•------------------------••----...------..........-•-- ----------------------------------- DATE ......... ADDITIONAL COMMENTS ------- ---------- ---------------- ......... = ........... .....•-•-•----•---------------------------------- ------------•1111----------------1111..1111 . -------------- ----- 1111.- _11111111 -• -- ....----1111-• --•1111--•1111--1111..... ... ... ..... .....•1111.- --- --- ...1111., 1111 Final Inspection b .111 1-1111-- ----•11111111-- PY� -•---- -• -- - - . -.. .................:......................•----.-.-1111•--------..........1111_Date ....'_�...Z...----�•----•-•-•-•-1111-- + EH 13 2L 1--66 dev• 5m SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3M