76-148 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: A �-APPLICATJON -.r:OR SANITATION PERMIT _. lComplete In Triplicate! —. ..� Permit Na. ..7.............. ¢ Date issued -`.. :!, Thls Permit Expires 1 Year From Date Issued 'Application is hereby made to the San'Joaquin Local Health District for a permit to construct and Install the work herein r described, This appiication Is made in.-Compliance with County Or ran a No. 544 and existing Rules and Regulotionst h 'JOB ADDRESS/LO ION .........!.` ..._ .`- ..:. ` .+� �'......... ....... ..........CENSUS TR AC'i .................... Owner's Namer ! j {{ � � Address { �.6 -...I. �hP � ----•-•... City ............ ..... Contractor's Name _._.. .._�...�.----....License z `� Phone Installation will serve: Reside ct `Apartment H use D Commer ' I' Trail Court �� ' MotelAOther ._15_.--------....................... ----- Number of living units:............ Number of bedrooms Garbage Grinder Lot Size g ............... Water Supply: Public System and name........- .........................:...... :_........------........ r va .P i to Character of soil to a depth of 3 feet: Sand 0 Silt Q Clay,❑ Peat❑ Sandy Loam p Clay Loam 0 Hardpan Adobe❑ Fill Material , .......-•---�lf Yes.type.........::................. .. (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) t NEW INSTALLATION: (No septic tanki�or seepage pit-permitted It •�•�yblic sewer is available within 200 feet,! f PACKAGE TREATMENT ( ] SEPTIC TANK j Si ... .. ....._.__. Liquid Depth,-•. •.-.......... Capacity 9 .`� Type--_----- -- ---- �•�- Material.. ��-.�.�. -- o. Compartments ,-J.T.�.�..0...... � Distance to nearest: Well ..�P.e..__....-T....._...Foundation ...................... Prop. tine .............___...._. LEACHING LINE ( ] No. of Lines ._��( ..... Length of each line....:_�._. ...Q � ......_..... g 7 ........-;---- Total Length ...... . �................, .......I. f %ZrrEr G 'D' Box ...... Type Filter Material --------------------Depth Filter Material..c�-�.•----........................,f .e Distance to nearest: Well.--�:�.,"�°'--.r. Foundation ........................ Property Line ...... J Depth ........1� ...._ Diameter 5.... Number ...........Z......d....I... !tock Filled Yes No 0 s�L4 IM ,' R . Water Table Depth :Rock Size_"'_1.. Z-:......--- 1� p -----------------••. ........ 1 Distance to nearest: Wellµ Foundation Prop. Line REPAIRJADDITION(Prev. Sanitation Permit# `. 'Date ....... ....._...... fF t Septic Tank (Specify Requirements) ...M. -•....................................................------._................................:.................................... Disposal Field (Specify Requirements) .. .....................-----............---------...---...... . ..-------•----. ...........----•-•-------•-•••-----............_................... ...- --•_.........._..-....---...............•••........... t _ _:...._._..........................•---------. ...._._..---.. _....-----------• •-•-----------.._- ..................... - ............ (Draw existing and required addition on reeverse side) I 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 Son Joaquin Local Health District. Home owner or Ncen- sed agents signature certifies the foliowirig: "I certify that in the perfor rice of the'yvork for which this permit Is issued, I.shell not employ any person In such manner as to bee s ole t # W r man's ai�ensation sof California." f Signed ... .. ........_........ .... Owner '! _ 4............... Title .... ................................ ( f other than owner) ........ POR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY' -M DATE ....-....:................. .... ... .. . BUILDING PERMIT ISSUED ....._...:_.._.......IV ----• ... ........:........................................................DATE .... ............. ADDITIONAL COMMENTS ........._....._._....!F---------------•-- ......:.............•.................-• ..----•----•---...--••----..............._.....---......._......_... ....... ................................ '� .................. ................................................ . ................................................ .......__!M:.:.. . ........:. ...._.......----.............__................._...----.•..--------._...__........_. .. , ............_. ..................... ............................. c final Inspection by: ............ ... .............................. ...............Date Eli 3.3 2!i 1-6fi tie �. '� .11;_14_ .._..._�......�. SAN JOAQUIN LOCAL HEALTH DISTRICT $ 311