76-480 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT a Permit No. .r�s=•-'��••• .................................... (Complete In Triplicate) _.. .............. Date issued . ......... ..... pp ............. . •__ This Parrott Expires 1 Year From Date Issued and A Jibed. is hereby made to the San compliance liancecal wi health County Ordinanistrict ce No. 549 and exisrmit to t ng RulestalndhRegu work described. This application is made p TRACT ........._............._.. 108 ADDRESSAOCATION ......�.....��......�. �� sy../�.�...5�...�.5.��.. . ��?.CENSUS ,- ..Phone ............... ................................... . . Ci Owner's Name }...._l.. .....--••-- k}..S �:r?.G.. r.l...._.... ty ......:S �t C ��- f........... ......... Address .�J. � ...�.7.-..-_. �_. ----._....- � .. License Phone .............................. Contractor's Name --------- •- - Installation Will serve: Residence 1@ Apartment House Commercial❑Trailer Court Motel []Other............. -----••---••----•-• ......... � Z-Q••��3• ••••••__� Number of living units_____________ Number of bedrooms ... . .....Garbo ga Grinder Lot Size Water Supply: Public System and name ---................-........-...................-............................................................ Private ❑ � W Character of soil too depth of 3 feet: Sand'❑ Silt❑ Clay a Peat❑ Sandy Loom o 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.) n. NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) 5ixe...................... ... Liquid Depth .......................... PACKAGE TREATMENT [ � SEPTIC TANK� j -•-'-•--'-•'••-"•-•' ' Capacity -------•------...--- Type ---•--------• .................. Material...................... No. Compartments ..---....-•••-•--..... ..Foundatn ... Prop. Line ...................... Distance.to nearest: ] 1 _ �' """'"" LEACHING LINE No. of Lines _._- _ ,_ Length of each Zine-._.___.._----- •- 9 . —j .l . Total Length 'D' Box............. Type Filter Material _-..................Depth Filter Material ..................................---....... Distance to nearest: Well __.. 4A!.r- Foundation -.N ---••-••-•-•---• Property Line ...��•............• SEEPAGE PIT [ 1 Depth -------------- --- Diameter ---------------- Number .........................-.. Rock filled Yes ❑ No //i� /i Water Table Depth ------------------------------------------------Rock Size ._.1, ..- •--•---•--- Distance to nearest: Well .Foundation ..... Prop. Line .................••-•• REPAIR/ADDITION(Prev. Sanitation Permit# _.....-_.----------------------------------- Date ----------------•-••----•-------••) Septic Tank S eci Requirements) ..................................................... ....•------•-............................... •........ Disposal Fi (Specify Re uireme ts) ----• ! C!�'-•-••• ----• / Cf� �- __________________________--------_----------------------------------____________________._._.--___---______�..._._....._.... ............................................................... (Draw existing and required addition on reverse 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 San Joaquin Local H*aIth:DIb dct. Horne 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 shall not employ any parson in such manner as to become sub t to Workma 's Com ensat10 �ws of California." Signed ---------- R L ` ' -------_----- Owner -- -- - - - -•------------ Title ------------------•---•-•----------------- ------------------•----•---- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ___. - DATE7:7. ---'' -----,-= BUILDING PERMIT ISSUED ------- ------------------------------------------ DATE - -----------...__._...--------•-.•--- ---- ADDITIONALCOMMENTS ---------------- _ ................................ --- ...... ------------- -••-----------...__.- --• -------- - ------- ---------•--------------- __._... ---------- ----------------- _ ------------._._..._..----------------• ...---- ._..._.....---•--..._._..._..---.-----_. ...- .... . Date -... . Final Inspection by: .. �................... EH 13 etc 1-68 AN JOAQUIN LOCAs. HEALTH DISTRICT 8/74 3M