75-7 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT - . Permit No. �.5� ... ................. ..............:) .1�...__.... ;Complete in Triplicate) .. - :_._.... Y :..:...... - L .. Date Issued j This permit Expires 1 Year From Date Issued r _. :........................... „ .� - ...t Application is hereby made to the ! i:ocal Health District for a permit to construct and Ins#all the work;herein described. This application is made_ in co_mplioisce,.with County Ordinance No. 549 and existing Rules and Regulations: _�I � . � CENSUS TRACT JOB ADDRf55/LOCATIO n o + ue l .'_.2��i Owner's Name .... ....... ....... Address . ._..... . °f --- -_-I....._......Gity `-- i . -- on /! Contractors Name ---..._.. Residence A artment ousefl Commercial: railer Court Installation will serve: CI P Motel ❑Othe ( Garbo a Grinder ............ Lot Size ........I........ Number of living units • . Number of bedrooms ...---..-- - 9 Water Supply. Public System and name � 11 �. '•� -- -•--_................•-----•--•---•••--..-.... } .Private 'v pp Y 1 ....... Y - -- Y Clay Loam Character of soil to a depth of 3 feet: Sand_0,� pilt,.©„q,,,.,Cicy :[]: Peat :. Sand loam {] Y i I- Adobe Fill Mcfe`ricl"� Y type (�Q Hardpan 0 ....if es a ............... ' n of s stern in relation to wells, buildings, etc. must be placed on y'reverse side.) !Plot plan, showings size of lot, locat io y I NEW INSTALLATION: JNo septic tank or seepage pit permitted-if pub{it�sewer is.available-within X00 eet, �•�,c_•j 1- Liquid Depth ... Al SEPTIC TANK Size------- -• ................ PACKAGE TREATMENT [ ] -------•----•---•--- Capacity .. Material.. =• No. Compartments .. .... p ty # Type - .... qT;•.; :..-.:..!.Foundation fib..'-.- Prop. Line __ ..._... r Distance.to ;nearest: WeII ___f.�`� _ "�--_._.__-- Len th of ead�!e�`�L�•-•••r•-•-••- Total; Len th -_- ....... LEACHINGry k 4b No. of Lines l g g .Depth Filter Material . e....... ...... ..... . I 'D Box . Type Filter Material p i r _5,..t7-...... P Distance to nearest Well S�.-,.f_•-- •, oundation�--- :�......._-__......Pro erty Line De th Diameter Number ..--- --•-Y••••---- R k Filled Yes A SEEPAGE PIT P }!''� I� f Water Table Depth ----••••-_..._ �..• :. . Rbck Size .1_!- -.�.I�c jf it f - P.R A�`+iri * .:: prop. Line ... ....... ....... {. Distance todnearest: ell .....15 fi !r- ..Foundation ---lQ.... ... j R>rPAlR/ADDITION{Prev. Sanitation Permit# • .._. R...___..._JDate .----..-.-•-------------••-- ) `'""' ' Septic Tank (Specify Requirements) •--•-"•-•---•--- -•-----•--•---•--•---•-•-•........"--------•-- • ......._... l ••..... ..............................••-•----•.... Disposal Field (Specify Requirements) -_-,--------•-••-----• ............. -•-""--------•---•----•---.....-"---••-----""•----------------•-•--.... - - - ...................................... .- ._. . - .. .. -•...:..............:..•.....--------...-._...............-- ................. • }{ (Draw existingand required addition on reverseside) I hereby certify that; I have prepared this application and that the work will be done In accordance with San Joaquin County Ordinance$,j.State Laws, and Rules and Regulations of the San Joaquin Local Health"District. Home owner or liven sed agents signature`certifies the following: .it in such manner ".1 certify that in the performance of the work for which this permit is Issued, i shall not employ any p as to become subject to Workman's Compensation laws of California." Signed - ----- --- ........ ........... Owner + (if er than owner) 1 F DEPART NT USE ONLY t APPLICATION ACCEPTED BY DATE;:._.__: ::........... BUILDING PERMIT ISSUED --------------------------- --------- ..:._ .. ------ - ---- .._.. _..DATE ---- �----�----------••--.................. ADDITIONAL COMMENTS .... --- -`- • G _ ....... .....--•-.----"- . .-•-------------- --- -----------------....------- -----••---• -------- :_ . .._.... l z,� .. / --- •--------------- --•------- ---•...... ..........•---•--...._..._Date ....-.--•----.... .x.'7.7--......_.---- Final Inspection by: -----�_*---• --- - EH 13 2h 1-6B Rev. 5M SAN JOAQUIN CAL HEALTH DISTRICT 8/7h 3M