76-970 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE, APPLICATION FOR SANITATION PERMIT Permit No. .7c` fc7 -- ' ' (Complete in Triplicate) ----' - Date Issued .1._........ . ...... ... ....... .............. This Permit Expires l Year From Data Issued ....................................... I Ordinance No. Sag and existing Rules and Regulations: ' hereby made to the San Joaquin Local Health District far a permit to construct and install the work herein application �s Y in com liance with County application is made p destribed. This app l CENSU .......... " ":" .. e LOCATION .. �'��.�• .._..u r ., . . . JOB ADDRESS/ ---• Pone " -..,,.M__w.. . - - _.T__ _.. _. . _ Owner's Name i --- -. . .. �.� .�-.._ . ...:.........rt--•'--- � , 'X3� Phone: . ... ..... . Address . . � fc ' t-� i ._.l can e:#' } Contractor's Name .-.. `" t`- Residence [ i4pariment-House'tD Commercial []Trailer Court ] installation will server y ❑ _:..:_ . I o l Other X -2- ---- i Mote c J ize _.'. -.... ✓� Garbage Grinder Lot.S Number of living units:..A/f r . f, bedropms.: rw :..Numbs - ---- ._. :-.........-.-Private Water Supply: Public System and name - Peat Q Sandy Loam Q Clay Loam.❑ x 5}It Clay ❑, I Character of soil to a depth of 3 feet Sand . 4 _., Feil Materiat If yes,type 1 Hardpan ❑ Adobe )� ' — , sided _ :etc. mint.be.,placed. on:reverse; '—� -A. relation .to,wells,:.bu,ildings, L f howin ' size,of Iot,..ioeatFon of.system { `EW INSTALLATION-.s. . g ; plot Ian ....SNo se'pti'c tank of see a e pit Perri itted.if'.public s6wer is available within 200 feet,}: Pg j / / i : `, �/ .,� .� � Liquid Depth � ..i �.. _Z SEPTIC TANK PACKAGE TREATMENT [ ] _ m artments z• Q l Material Q No Co p 4 Capacity ��•- - c' Type �` 'Line t Foundation .t. L Di'stan'ce to nearest: --• Well ro I _ - ch�Un - Tota .Len .-. Z k • ,r Length of ea e ; f Lines I LEACHINO LINE t[�J No. o F,Iter Md#er-.ial 'D` Box .{ �TYPQ F�Iter Mate. _ _ Dep P e _ l :� C: ovndatiorti 4h . I. � rgperty Lin es = L l f- Distance 01 nebresf-:-Well �� F Rock Filled' Yes Q� No rn SEEPAGE PIT - ; .Depth..:, $ Diameter - Number -z -r ..�....�— [ ... - -Rock Sze Water ,Table. Depth. nsarest'Well tsc: _ • k .:� - ' Distance ta:. . . . _ . Foundat�on�._ I q prop.._Line- � a h Permit# Datr; ITIONIPrev. Sanitation: ---_-.-. ... _ .... REPAIR/ADD :. • -- f !Septic Tank S ecif Requiremenfsi .. . , ..`.... [ p Y' . +Disposal Field (Specif Requirements} - ...__:---- - :_. ... :.._.._ g q ' {Draw,existin and required add�tEon on reverse sidel ` 1 hereby certify that I have prepared this application and that: the' work will be done in accordance with' Sari Joaquin County Ordinances, State laws, and Rules and�Regulations'af the San Joaquin local Ilan{th District. Hoene ownar or licca:+ ' sed agents signature certifies the following: : ermit is issued; 1 shall not employ any person in such manner -I certify that in the performance of the work for which this p 1. as to became subject to Workman's Gompensafiion {aws.of California. g - -'-- Owner - iSigned. .. ...... ..,_ -�---- •._ .. �,�_: _. : - --•----- Title•.:_�� ....;...........::.:._.:......:..- By .... {1f other than owner} FOR DEPARTMENT 115E ONLY DATE :. 1/�../... APPLICATION ACCEPTED BY .. ! - "` DATE .. ._ ..... _ i ...._..-. .,.. BUILDING PERMIT ISSUED - ....-•--'-. ---- ADDITIONAL COMMENTS .:._.... - ........... ........ .._...... �.. ......:................ . _.. /• � � , � ...'.. ate •- -�--f� . . Final Ins action b SAN JOAQUI LOCAL•_HEALTH_DISTRICT., - 7/72 3,K.