76-128 - Laserfiche WebLink

Home Browse Search

FOR ... OFFICE USE.• - APP,L1C�A t!OW FOR SANITATION PERMIT Permit ! ; _.. -a .. mpl {Coete In Trlplitate) 4 JI . ...+.. t, r - :. i............ ........ ..... -l3-7 is :.........:....... Date Issued This Permit Expires 1 Year From Date Issued :-----• ( Application is hereby made to the San Joaquin Local Health District fora 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: � 1 JOB ADDRiwSS/LOCATION � __/1 .................. US TRACT ............... CENSUS 3 Owner's Name ..../S.[.41.1.C".. :(/t.3!_._..--•--................................. ...}......:-•.........._..................Phone . . ... .... __ .. .---•---- Address �I �l .:.............. Contractor's Name .. e :.. � _ :. ;;.:;� V��:_.................'-.License# .��rJ��.._. Phone Installation will serve: ResidenceApartment Houser] Commercial oTraller Court ---- .. :. ,. -..._...Motel rlOhi Number of living units.- J.------- Number of bedrooms _.R_...Garbage Grinder /VK... Lot Size ........... Water Supply: Pub c��tstem and name _________________________ .... ...._ ..........._Private 0. Character of soil to a dep*of 3 feet: Sand o Silt Q Clay o Peat Q Sandy Loom 0 Clay Loam ❑ .._+.-.Hardpan.[1]_Adobe Fill Material ............1f yes,type............... ............ (Plot .plan, showing size of lot,' 'location of system in relatlon to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATIONS (No septic tank or seepage pitp re mitted If public sewer is available within 200 feet,) PACKAGE:TltEATM€NT j ] SEPTIC TANK Size.. , .. ....... Liquid Depth ....7"�-.... I Capacity /02P1?:..,•-_ Typa :.& Mat No. Compartments _ ------ i Distance.to nearest: Well( --••-•...... ................. .. Foundation . _. ...... Prop. Line ......... k LEACHING-.LtN ;U ; No. of lines Length oU tach line.---.14 9.1.1 Total Length _,/_.l�.�.....:........... .t D' Box .Jype Fil#er Material /flg:��:..Depth .Filter Material ...................................... o . Distance to nearest, We �.....:...ll .:-.Foundation .., C�............. Property Line —1................. . SEEPAGE PIT �- -- --- SA T � Depth :_F. _ -dz_ Diometer � , Number ....---�.... ............ Rock Filled YeNo ❑ �. j Water 'fable Depth _J_17.. Rock S Y.l -- --•- 9 ..... .--- . Distance to nearest. Well ^ r .:..Founds - ---- ------------- Prop. Line .. ....._..... 0 REPAIR/ADDITION(Prev. Sanitation Permit# .............................................. Date ..................... Septic Tank (Specify Requirements) -•-- ----------------•- ................ ._:............................. .,Disposal 1'Field (Specify Requirements) .•........................ .................. . -----•-• -•--------------•------------. ........................ ,, - ------------------------------------------- --------- .................. --- -- --------------------------------------- ------••-•----.....- --------•-------11------------------ •_.. ....---....... ..•----------------•------....-•-•--•••-- ••-------- (Draw existing and required addition'on reverse side) I ;hereby certify that I have prepared this applicatlon'and that the work will be done in accordance with San Joaquin i County Ordinances, State Laws, and Mules and Regulations of the San Joaquin Local Health:District. Home 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 person in such manner as to become subject to Workman's Compensation laws of California." t SiYgned f '� == Owner --•-------------•---•--•----•- �L (If of Flan ow F dr FOR DEPARTMENT USE ONLY BUILDING P -- �- ; APPLICATION ACCEPTED BY .---- • --•---------............... DATE-_ .................... :_............_ PERMITISSUED -------'-y------:-�'.'�..'.............:...............•--........----•----...._..---.............._..__._DATE ------.....-------•---...�._......---•---- ADDITIONAL COMMENTS .. is = `-----•--:r-----------------------------------------• —--..---......_....... -•---••-•--------•------- li i d ;/•- ........................... ------.---------........_..a....».._:........-......F:_......__,-...._------------ - ---........ ................................1 :...... . . ............................. ------------ -------•--•---------- --------------��._ r ------f..-f_"�.r finallnspec = :.._._.. -•--------------------------------------•---.........._..... :------- , Inspection b " . r, r' ....Date __.................:cf:................. .. 13 2b 1-68 Rev- 5M � SAN JOAQUIN vZ:AL HEALTH DISTRICT 874 3M a �