74-682 - Laserfiche WebLink

Home Browse Search

W ; FOR OFFICE U E; F �� APPLICATION FOR SANITATION PERMIT 1. Permit No. .1-c/76•- z' ............................... (Complete in Triplicate) ............... ..................I................... - - Date Issued .__�"s_'1..y... This 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 described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: �Q ,?, JOB ADDRESS/LOC lON . CEN .................... . . .... ............... CENSUS TRA Owner's Name ..... . .........P one ��..._. .. - ._ G 1,�.- .. ... Address .................. ... _.y� _. ` .... .... city .. .. . a�' S Contractor's Name ....... ,• ••••-- License # ., �� •7.� Phone . Y Installation will serve: Residence Apartmen House Commercial ❑Trailer Court 0 Motel ❑Other ..................................I...... ... Number of living units:----..------ Number of 'bedrooms..........--Gad 5age.,Grinder _._. ....... Lot Size ------------------ •••....................-• Water Supply: Public System and name ....... P[iv�te ❑ Character of soil to a depth of 3 feet: Sand'[] .Silt❑ Clay ❑*', t-� Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material .......----- If yes,type .......................... (Plot plan, showing size of lot, location ofsystem in relation o wells, buildings, etc. must-be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitte Jf~public-sewer-is-available within 20Q feet,y —-- t PACKAGE TREATMENT [ ] SEPTIC TANK I'] Size....... .. ............ ..••• Liquid Depth ........................... Capacity -- -T a .-•-•••------------- Material•-- ......---•- No. Compartments ... t ........----....... i _Ip ty .................Y:. -Type ; L Distance to nearest: Well -------------- - -- Foundation ......:......•.•••..__. Prop. Line -=-........_.. ....... I LEACHING LINT: [ ] No. of Lines .......... --••-------•• Length of each line..........................•. Total Length ............................ { ...De Depth Filter Material r � D` Box Tye Filter Material --•------------------------•--•-........._.., p Distance to nearest:'Well ................ Foundation ......_.. ------- ...... Property Line ....:................... Diameter Number ....................... ... Rock Filled Yes 1i No �❑� I� SEEPAGE PIT [ ) Depth 6 Water Table Depth ' Rock Size ................................ • ... ... Foundation ....... Prop.• Line ......................7. Distance to nearest: Well ---••---- -•""' - Date � REPAIR/ADDITION(Prev. Sanitation Permit#` "'I Septic Tank (Specify Requirements) ... ...........................:......•--- ---.....--- ...................... Disposal Field {Specify Requirements) .��:......----- -� .......................... .......................................•-------•.....----------............ ...........----------._....-------•--------- -------------------------•-•-----•-- -------..r.-------_-------- ............. ............................. ------ ............... ------------------------- v {Draw existing and required addition on reverse side} 1 hereby certify that I have prepared this application and that the work will be done' in accordance with San Joaquin and Regulations of the San Joaquin Vocal Health District. Home owner.or County Ordinances, State Laws, and Rules licen- q sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." l ° �._--�---�-� ......... -•. •--------------- Title ... 7 E BY�jc�(.1V .....--------------- (If other t n owner) FOR DEPAR MENT USE ONLY APPLICATION ACCEPTED BY .. •. -- ....................................... DATE ... ... 1., :_ .... ............•_. BUILDING-PERMIT"ISSUED:"�`:�„�.---__. _.. . ........__......... DA I ADDITIONAL COMMENTS ...............................•---------•-------- I. ............1-1........................ ... ..... ..................................... ........• ._.......,... -.--_.. .... �_ _....... s_....`__..._.......... __.... _ '- __.......__._. .... - ._.....:.. Date .............. Final Inspection by: .- �--- � ,,--- .............. .: . ..... SAN JOAQUIN LOCAL HEALTH DISTRICT 7/72 3 114 �, 13 24 1_-s.a ao" Flu -- -