74-179 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: 77 f/T I APPLECATiON FOR SANITATION PERMIT permit No. ....._7...f_..._..... ZZ7 rt ....._. (Complete in Triplicate) .........4.................................... Date issued .�_��`�.�� This Permit:.Eitpires"I Year From Date Issued ..................................................... _ - Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein ; described. This application is made in co plIonte with County Ordinance No. 549 and existing Rules and Regulations: �1r1'-'��!1�� , /ems........................CE JOB ADDRESS/LOCAT)ON;.q CENSUS TRACT l� , ................................................... .......Phone AW-11 � •• Owner's Nome ...._ .......r A7775 Address . � � '= + �� .._........ City _. 3 Phone ... 1� a ;� . e ' � .... License # ..7 . r. ne Contractor's Name Installation will serve: Residence 5(Apartment House❑ Commercial ❑Traller Court 0 i Motel ❑Other _... . ---------•--••••. I 4s�- 'F ...-_ Number of living units:._- ..... Number of bedrooms ..-...Garbage Grinder Lot Size . •-. Water Supply: Public System and name _......- ------------------------------------------------ ................................................... i Character of soil to a depth of 3 feet: Sand ❑-Silt F] Clay ❑Peat E3Sandy Loam [IClay Loam Hardpan E] Adobe ❑ Fill Material ............ If yes,type ------- -------------------- (Plot plan,Ian, showing size of lot, location ;of. system in relation to wells, buildings, etc. must be placed on reverse side.)� t. .•Y a NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) ;TANK Size_ �` J...... ..._.._ Liquid Depth PACKAGE TREATMENT ) SEPTIC Material 0.-- Compartments °�................ l Copacity�_ .�?.F------- Typ 1' Distance o nearest: Well 1.610...........•.............Foundation .._40f.------._. Prop. Line .&'.. .._ Length of each line-•---- a Total Length -�C_M ............ LEACHING LINE UQ No. of Lines . g 'D' Box �� Type Depth Filter Material .1. ................•-�-•-s-•-•--•-••=-••� Distance to nearest: Well _1d'°.Q............... Foundation ` ................ Property Line ..................... ' i Ole 64 r SEEPAGE PIT Depth _ + ::..'' Diameter - --•--- Number ...... .......... Rock�Filled Yes�j No Q Water Table Depth'_Zlev -----------6..............Rock Size/. ,/......... r ..Foundation LO. - Prop. 'Line `............. Distance to'nearest:-Well"_ _� . " ,�. REPAIR/ADDITION(Prey."'Sanitation Permit�# ..-.•-•----- --•------ Date ..................................) Septic Tank (Specify Requirements)-!----------_- .......................... ----•---•••-•----------------------.----------- _.... Disposal Field (Specify Requirements) ---------- - ---• ---------._......---------.---.__-----._...___..__.. � -----•. .................................-............................--------.......................... ......................... a r. Draw existing and required addition on reverse side) I hereby certify that 1 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 District. Horne owner or iiten- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner f as to become subject to Workman's Compensation laws of California." Signed ------------- . ..... ---........... Owner Title '�` , f+/ )9 (If other,than o ri z R/001ARTMENT USE ONLY ' - ��D�ATE ... -f !-= �`......._._.. APPLICATION ACC> PIED, BY ......_. . DATE l BUILDING PERMIT ISSUED : ADDITIONAL COMMENTS` ......... .. . .......) .............. _._.... - ;-. ... ....................I......_......_----• ............. ......... ........... ..}.. ... :' --........Date .... I Final inspection by. .--•--- -•-••- . ..... I......................... ...... SAN .......... -•---•---•....:._•--- SAN JOAQUIN LOCAL HEALTH DISTRICT CT) i , � �,- - - -•• � T/723M