73-1134 - Laserfiche WebLink

Home Browse Search

n,dVt Pdev G FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 73//3 f Permit No- --------------- -- t ------.................I——.................. (Complete in Triplicate) Date .--•....................••--.... Issued .� :7�e_ '3 i .. ._._. ._._..__..__.. This Permit Expires 1i Year From Date Issued and l the work Application is hereby made to the San Joaquin Local Health District Ordinance Noer'm549 and existing Rulestalnd Regulations.ein it to constr described. This application is made in compliance JOS ADDRESS/LOCATION .....I6.$b "... ._...GftlN.�....R.c�.' pt=Q. vrn ._..._CENSUS TRACT .:...................:.... ' Phone Owner's Name t�Q.�IY........ .._�!:fJ!N.�.�:A.:................ ...........I.................•--.:......_. Address .................... ... ................................ City ............................................................................ Ft �k�!1 d/v ►�/ License # lei ."rT Phone ter... Contractor's Name ..------... --... •• -- . Installation will serve: v Residence C]Apartment House Commercial ❑Trailer Court 0 Motel ❑Other .......................... ................. Number of living units:.,-./..... Number of bedrooms ...,1......Garbage. Grinder -----------. Lot Size .....R14A! ;A--••------_-- • Private !RJ Water Supply: Public System and name ................--------- -------------------------------------------- ---....._...._....---••- -•-- Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat❑ Sandy Loam .0 Clay Loam Hardpan ❑ Adobe❑ Fill Material ------ If yes,type ............................ (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 TR>:ATMENT SEPTIC ] LP Size.----.... 5 .... Liquid Depth ---••----... :- Ft r /size. t S�� Ia Capacity':; -0p�4. TYP Material.................. No. Compartments ...: _. ....._..... y 0 . F., ...---..Foundation �� .....__.. Prop. Line . O Distart`te `to•'nearest: Well .........................•-- ......__._... , - . f ....--- Length of each line. LEACHING Total length : �1 ........ LEACHING LINE [ ] No.`of'Lines3..-..- D`k Box . /..=_ YP r Material �?:._qo R••Depth Filter Material --�¢•- -•-• Type Filter 'i i I Distance to nearest: Wel) :.......-.S......... Foundation ..._. ............. Property Line ...��---•._...... �i r _ Rock Filled Yes No ❑ SHPAGS7 • [ 1 Depth .../A------------- Diameter l` .. _ ._ Number _........_........_......_ . S Water Table Depth Rock Size -------- ........................ Foundation Prop. Line.... Distance to nearest: Well -------------------•••---•-••---...__. --------.....------- i REPAIR/ADDITION(Prey. Sanitation Permit# ............................................. Dote •--- ----------------------------- Septic -----•----•---• --Septic Tank (Specify Requirements) ---- ----------- -------- ............................ ......... .... ... ................... .... Disposal Field (Specify Requirements) ------- ------------------------ ................... . ................................... - ------------ ....................----- ---------.....--••-•-----......_..-•-...--------•-•------ • „ ---........ ' ------ -----------• ........ •----- -----------------------------_......................•----------•.................................-•••--. •••.._... (Draw existing and required addition on reverse side) f l 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 District. Home owner or licen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, I :hail not employ any person in such manner as to become subject to Workman's Compensation laws of California." ----- g !Y �P _... f._. alY. Owner ( Si ned ._... r. . xitie ........................................... (if other t an ner) y FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .__._.- - . .............................------....------•---•-....---_.. DATE ..•. ... •�- .- -• .. BUILDING PERMIT ISSUED .........DATE ...:....:... ...:.................... ..... ADDITIONAL COMMENTS --•- ••--•..................... = .......... 11 ----------- .......... ........ ......... ... ....----........ . ...... ............ .......................... - I ........ ate Fina{ Inspection by: . D ]. . SAN JOAQUIN LOCAL HEALTH DISTRICT r 7/723.,4