75-806 - Laserfiche WebLink

Home Browse Search

AOR OFFICE USE: 4 U• °�°'J� -ci ao '21 S APPLICA 6l* R SANITATION PERMIT 9 a Permit No. .r...�• `----•- _ �................................ (Complete in Triplicate) ,. Date Issued.0. This Permit Expires 1 Year From Date issued ...................... -------- 02_t-,_)q0- ( to Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein describer!. This application.is made in compliance with County Ordinance Na. 549 and existing Rules and Regulations: _ ........ JOB ADDRESS/LOCATION ,. ..10••.x- �, ! �/ U �! .Qrll SVS TRACT ......•........ f � 1 �j�' Owner's_ Name _.t�tE.A-.�/.A/L.._ L 0.. _. G�I . ....................... Address .-. ........:..................... ....................................•- _ City ........................................ `,' F Contractor's Name -_ e,� �.1�N. lit �El!_ 1..D.N.._...License * ....................•... Phone ....s ,. �:s.:•.';s.� ��1� obo aiLOII�� Installation will. serve: Residence);I'Apartment House t] Commercial ❑Trailer Court ❑ Motel ❑Other .......--------............................. l , Number of living units:--L._. Number of bedrooms Garbage Grinder Lot Size ............................................ Water Supply: Public System and name Private >( Character of soil to a depth of 3 feat: Sand ❑ Silt Clay ❑ Peat❑ Sandy Loam 0 Clay Loam $ z • t Hardpan.W Adobe ❑ Fill Material ............ If yes,type ............... ............ I (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.! W NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet) J � PACKAGE TREATMENT [ SEPTIC TANK Size------/2).q.9...........••--•-••••--..._ Liquid Depth ..17�..''............... �tl , o r� Material..h�----�- No. Compartments ...................... Capsacity .... Type --------- -----••.- Distance to nearest: Well 1,}�f.... .....Foundation --- Prop. Line ............:......... i LEACHING LINE [ ] No. of Lines ----. .---•-•------- Length of each line----(0� Total Length � �......-••....... _ 'D' Box ............ Type Filter.,Ma _....Depth .Filter Materia)terial ........------- ............................................ � I f j l .... Property Line k Distance to nearest- Weil .. �- •.. Foundation . No SEEPAGE .._. Rock Filled Yes Q PIT [ [ Depth .�--- --- Diameter c ..- Number . Water Table Depth .................................Rock Size ...___-.--•. ........... Distance to nearest: Well 1,S.C?�.. .Foundat+on .... Prop. Line .................... REPAIR/ADDITION IPrev. Sanitation Permit# •-------....---- ••-------------•----------- Date .------- •••••••--••-•I F - Septic Tank (Specify Requirements) ......................................................... Disposal Field (Specify Requirements) _-----•--------------- --------------------------------------------- -_----------_-_---._.__----...---...._.....••--•-...._...... -- ---- -- --- - - - --•-•-- (Draw existing and required addition on reverse sidel 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 Iicon- sect agents signature certifies the following- ''I ollowing:'"I certify that in the performance of the work for which this permit is issued, l shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed ,. •-----• ------------------------ ---- -•----•--_- ---- •-y- v Owner B. ��''-`- ' -...-- itle ��-- - ------------- (If other than owner) ( FOR DEPARTMENT DISE ONLY iT --.-- ---------- ----------- DATE . ;lD -l4 _ APPLICATION `ACCEPTED„BY __.-_-_-- --- •--- BUILDING PERMET ISSUED-_/- ----- -- ----- ---- ---- --------- - -- D ADDITIONAL COMMENTS e�' 6 T_ �d --- --- •---------- ---------............ ..................... •---------......_.. ----------- -------------------------------- ---------- .......... .._...I .� --.------------- -_,...---------------._.......<<: ._....._. ......... a-` ......... s.._.-.... Date Final Inspection by: _ _ _ .... f EH 13 .24 1-68 Riev. 5i SAM JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M