77-320 - Laserfiche WebLink

Home Browse Search

FOROFFICE USE: vt}, APPLICATIVN FM SANITATION PERMIT ...•.... .........................•---•...._•-•--- 3J>a 1 (Complete In Trlpilcate) Permit No. ......�7-... ....-3 ......•. ... .... ....... ............................... This Permit Expires 1 Year From Date issued Date Issued ..: a.-77 Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work heroin described. This application Is made in compliance with County Ordinance No. 544 and existing Rules and Regulations: 3o c7va JOB ADaaEss/LacATioN .....,...._.....---...��.�e.l�!..84... .....I...k..A1.cINsus TRACT .......................... Owner's Name .........8v.Ac.?e-.r--.......1x2ivej...................................................................Phone .................................... Address ............S. i*t ........................•. ...City . . .......................................... Contractor's Name ....!__�:/4n�T./ wry t` �' ...............................License --.. Phone Installation will serve: Residence[2'Apartment House f-] Commercial QTrailer Court 0 Motel[]Other............................................ Number of tieing units:.......I.._ Number of bedrooms ---l......Garbage Grinder ............ Lot Size --------------- ..................... Water Supply: Public System and name ...S t!!.__%TOAP!!.*.._.l4' G ,.Prlvate❑ Gr Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat Q Sandy Loam 0 Clay Loam a Hardpan C] Adobe O Fill Matorlal............ if yes,type............... ............ 15711 (Plot pian, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.ib NEW INSTALLATiONs lNo septic tank or seepage pit permitted if public sewer is available within 204 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK f ] Size------------------------------------ ----------- Liquid Depth ..... ................. Capacity ...... Type .6..IST Materia l.4-K��K<...... No. Compartments ..?�................ Distance to nearest: Well ................ ..................Foundation ----1 C.........._... Prop. Line ..:E.................. LEACHING LINE [ ] No. of LinesLength of each line... Total Length 'D' Box .....t.... Type Filter Material ....Depth Filter Material ........ "........................ Distance to nearest. Well ...... Foundation Property 3' .................. ................._...... Pr Line ........................�. SEEPAGE PIT { } Depth Diameter ................ Number ............................ Rock Filled Yes ❑ No 0— Water Table Depth ---...---••................... .................Rock Size ................................ Distance to nearest: Well ........................................Foundation .................... Prop. Line...................... REPAIR/ADDITION(Prev. Sanitation Permit# ...... ..................................... Date ..................................a Septic Tank (Specify Requirements) ...... .................. .......... ..................._.......... .............................. ,............................. Disposal Field (Specify Requirements) ........................•............--•---.........---•-----....._......................._........._................................ ---------------- ...............................--.............................................. ................ ------------•-------.........------•---...._..--•---•--..................._........ •---•--------------- ----------------- ...... ................................--.......................................................................................................................... (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 Sae Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Neoitb District. Nome owner or licen- sed agents signature certifies the following: "I certify that In the performance of the work for which this permit Is issued, t shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed ...._. %�!!l.T�.QAI,(/.•-- .7?� Sc7A/................................ Owner BY ------ --------••..._...... •---- Title .......................................... (Ifo mer FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ........... .. .... - ................... --•-.... .. DATE ..... � BUILDINGPERMIT ISSUED ........ ....................... ---•••......-•--•-• ------------•--•-----_.. _.--.........DATE ---- ..................................... ADDITIONAL COMMENTS ------------------- - -•----•---•............---••-... :......__....... ................ .................................. ---•---- ................___.....................__.._.............................. ......._.......... ._...... --------------------------------- ........... .:......................--- - ..... Final Inspection bY. .. � r....•......... ...................................Date ................ EH 13 2!t 1-68 Rev. jSAN JOAQUIN LOCAL HEALTH DISTRICT 8/71; 3M