76-580 - Laserfiche WebLink

Home Browse Search

rVK UFFFCE USE: _11Z. APPLICATION FOR SANITATION PERMIT ................ -------------------- {Contplet�in Triplicate[ Permit No. 7� � ........................................... ......--•---- This Permit Expires 1 Year From Date issued 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 AD.,_DRE_SS/LOCATION &/.P,-q ,�. . z= 4 -Owner's � ... CENSUS_TACE ........................... Name ..... Address .. i Phone . City Contractor's Name - 11!I .C, ! ...-- License .� ' Installation will serve: Residence 0 Apartment House Commercial QTrailer Court 0 � Motel 0 Other_t.L —r . ��G� Number of living units:=—:-- -_ Number of bedrooms _- ......Garbage Grinder ---......... Lot Size ............... Water Su ...................... .� Supply.. Public System and name _.______..-. L3 Silt-------•. Cloy ..._Private ❑ Character of soli too depth of 3 feet: Sand Silt❑ y ❑ eat❑ Sandy Loam �iay Loam D _ Hardpan 0 Adobe❑ Fill Mcterfal ............ if yes,type (Plot pian, 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 [ l /11 i SEPT C TANK{ Size__-g�ei✓__ef-�.", Llquld Depth �................... 1 ...---- .. -- .Capacity � Type --•-•--•-------• -- Material--r ?s-<��___ No. Compartments ......... Distance. to nearest: Well _...._:.1 _61 -Foundation .... A� Prop. Line ...-._ LEACHING LINE [ � No. of Lines � .---------- Length of each line.__-�e4 " _ • Total Length . D' Box _.:=77-- Type Filter Material ...... .filter Materlal .._ .--`.f--. f.. ,Distance to nearest: Well _...._.110.4 ._ ..-- Foundation .._.f� -.,-_. � f11 -- --- Property line ....1�/f SEEPAGE PIT - Diameter --. Rock Filled Yes ❑ No C [ 1 Depth .--�--�...>--------- Number -------------•--._...-- Water Table Depth .......:......... . • ; Rock Size Distance to nearest:,Well ................................. Foundation ...........-........ Prop. Line ..... REPAIR/ADDITION{Prey. Sanitation Permit ._-:---_-----'----_. _-__ Date ................... Septic Tank (Specify Requirements). .__..-.-=•-: - Disposal Field (Specify Requirements) ..... .. 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 Satz 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: s "� "I certify that in the performance of the work for'whlcft this permit Is issued, I shell not employ any person In such manner as to became subject to Workman's ompensaticn laws of California." Signed -----•------- ---- --------- r Owner t --- -- BY --- ------- ----------•----------- -:._.... :_:. . ._ 3itie --------------------- (if other than owner) lee FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - ----- ._.�------ -. ` •-------•-------- ------ DATE .. " z- .�7 ......- Bf1lLDING PERMIT ISSUED --------------•..------- " - ------- -•--------- - .. - DATE ...................... . ADDITIONAL COMMENTS -------- - ----- x __... - .............. ---------------------------••----------••-------•............... _-----------------............. -- ....--- l Final Ins p ection b ------ -------- ---------•------------------------------------- _y EH13 2h 1-68 Rev. -------------- ---- --------- _. _. _._. .. ----..._....Date ......... ................. SAN JOAQUIN LOCAL HEALTH DISTRICT 8/71i 3M t