77-201 - Laserfiche WebLink

Home Browse Search

IFR �FiZIE 41 APPtICATt4N FOR SANITATION PERM permit No. ..?7� ........... ....................................... (Comp)ete In Triplicate) . .. Date. This Permit Expires t Year From Date issued .. �7 and Application is hereby made to the San com9 Bance with Health District i trio for Ordinance permit to 0 and pxl�st�1 9 Ruiestalnd Regulatlana�eln described. This application Is made in-- p ' CENSUS TRACT JOB ADDRESS/i.00ATIOU - :._.........Al►one ... Owner's !dame . ....................................... ...... . .... �. .:..... Address .:._.`....----•:• •- ---••---- Pho e �'"� - ..License ..--- n" ................ Contrdctor's Name ................................. ------------ - installation will serve:' a dance partment House 0 Commercial C]Traller Court .0 4 Motel❑Other .................................... ............. Lot Size Garbage Grinder ..................... i Number of living units:_--__-._.... Number of bedrooms .- -• ." -..................Priv" System and nam . ...... . ...•-• •- •-••-- ............................_....---..... Water SuppI : Public Clay Loam [] Character of sail to a depth of 3.-feet: Sand❑ Silt[3 Clay ❑' Peat❑ Sandy Loam C) . ' Hardpan®, Adobe❑ Fill Material ............if yes,type............... ...-••-.. .. { showing,size .of lot, location of system in relation to._Wills, buildings, etc. must be placed on reverse side.) (Plot plan, g NEW INSTALLAVON: (No septic tank or seepage pit permitted if public sewer.is available within 200 feet) -' - Liquid Dep . Size-.' Depth ........................ � PACKAGE TREATMENT: ( ) SEPTIC TANK p ate ial.................•.... 'Na Compartments �r�... . A r- Capacity��F _ . _ -• Yim rlal...................... f -f• .. -.Foundation ............... r ..... _ Distance to nearest: Weil ._j1�f� .l� Pop. Line - ..... • Total len th .a.�•,/ ^.... 1 LEACHING LINE [ ] No. of Lines _. ---- Length of each iine: �..:................. g .... `D' i}ox ..�....... Type Filter:Material _ ' 4 Depth Filter Material ............._:.........:...... i on ... ... -- ....... .. Foundati property Lin`s Distance to riearest= We ::--...... k ❑ NO C3 ' `'Diameter Number Roc Filled Yes SEEPAGE( 6;<-. Dep ::.:: ...: .... ... Rock Six - Water Table Depth ................................................. e .. ........................ { :- ......Foundation .�'""""�`Prop. line ........... Distance to nearest:.Well -� '` .-__ ... Date � ) REPAIR/ADDITION Prev. Sanitation Permit# ........----•--- Se tic Tank (Specify Requirements) ..........................._. ........ ._............... .-k............... ............ . .....�.............�.....:.... .. Disposal field (Specify Requirements) ........................... ..... ........ - ...- ....... ..................................... ...................................................._.__........: -- --•••-••-...._...._..... ................ _..._.I........ ,. r -• .................................. r - (Draw existing and required-addition on reverse side) I hereby certify that I have prepared this application,and that the work will he done In accordance witls San yeagnln County Ordinances, State taws, and Rules and Regulations of the San Joaquin Local Health District. Horne owner er 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 Workma s Compensation laws of California." !� ,. . . �i ' . Signed ............................................................ Owner .......- Jitle...................................................................... ......................... (if other than owner) , FCA DEP E 11 ONLY APPLICATION.ACCEPTED BY ..... ...... . ....... ............, ..................... DAT . ..`.. . -°.-........._ BUILDING PERMIT ISSUED ..... .... _..DAT ........::..... ....... .......... ........ ' ..............•--.. ADDITIONAL COMMENTS ......................................................... ................ .. ......................................_-.._--...-----•...-...........-----...............---.-....-.. ..:. ............ •----........ ........ .......--...........-....:................................ ......... ..........:.................. Dat 7 . 1--sr .-....... r final Inspection by: ..... ..: Fri 13 24 1-68 V. 5i SAN JOAQUIN LOCAL -HEALTH DISTRICT �� s .