76-1055 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: IAPPLICATION FOR SANITATION PERMIT .......... ............................. 7��/ds� ......._......................---•-••••••• .............. (Complete in Triplicate) Permit No. ..__---...•.---.__-__ ........................ ..._.......... . hDate Issued is Perntlt Expires 3 Year From bah Istwd /.Z.'. Application is hereby made to the San o qu n�%ww h District for a permit to construct and install the work-herein described. This application is anode in pliounty rr ir�ar� 0p.- 49 and existin Rules nd R6gulations. JOB ADDRESSjACATiON �_ I? Owner's Name .1- cJ0&!7w,g.k#---��%�l'�_._I..�M.s��T.9?r.�`.,ey�. ..A.�............. .........Phone Address lw..�•�` ........... City _ ..... .4Contractor's . Contractor's Name --...._..---e__.-__-•_ �. -Eiaense +# �lCs Phone '4-�&.-R4�7 Installation will serve: Residence❑Apartment House C] Commercial❑Trailer Court Motel }]Other ......)2_0 A I'Z\ Number of living units------------- Number of bedrooms'2 Garbage inder of size ---- p ��..................... ' �... Water Supply: Public System and name _.. . k ..Private Character of soil to a depth of 3 feet: Sand E] Silt❑ Clay ❑ Peat Sandy Loam ❑ 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 sli:1 4Z NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,} cl PACKAGE TREATMENT ( ] SEPTIC TANK ze__.,s _ .1 .. Liquid Depth .................... Capacity t� Gam_._... Typ 1 �. id-Material ..__.--- No. Compartments .... ....._....�+. ` \ Distance to nearest: Well A �------------Foundation ----Z-45..... Prop. Line �.......�r .......... _ LEACHING LINE � No. of Lines ......./............. Length jf each line..•--� -�--....... Total Length ._...7 ��..f........ V Box ............ Type filter Materia Depthfilter ilter Material ...... ........................ Distance to nearest: Well s...... Foundation .. _..©. ........... Property Line ......4�.............. SEi PAGE PIT ' Depth ---- Diameter Diameter --g Number ......... ....... Rock Filled Yes � No 0 �• f Water Table Depth --- � ----------------- -------_ .Rock Size _.� .� f! Distance to nearest: Well ..........--•------------------.........foundation ._.. .. Prop. Line ........4... .... REPAIR/ADDITION Wrev. Sanitation Permit# ............`------------------:`.._........ Date ..................................} Septic Tank {Specify Requirements} _._ ....................... Disposal Field (Specify Requirements#. __ _-L. •--- .............•--- --� ...._. w _..... ................... --•-----•---•-----..........- ---• �............-•--........... •..- -cam ____ __ (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. Home owner or licen- sed agents signature certifies the following: "1 certify that in the perform a of the work for v#ich this permit is issued, I shall not employ any person in such manner as to beta rr►sublet to W n's Coensatio aws of alifornio." ]� Signed --- ------•L-•--- By --------------------------------------- 3itle (If other than owner} _ FOR DEPARTMENT USE ONLY 4 ` APPLICATION ACCEPTED BY -------- ------------- ---------------------------• DATE --- ------ BUILDING PERMIT ISSUED -__--•- -__--- ATE . ........................................ ADDITIONAL COMMENTS �.�. ---------------------- Final inspection by: • . ................ Date L-z -3 r.�_ ------- EH 13 2!t 1-68 Rev. 5m SAN JOAQUIN LOCAL HEALTH DISTRICT 8/743M