78-912 - Laserfiche WebLink

Home Browse Search

-'"FOi2 OFFICE USE, APPLICATION FOR SANITATION PERMIT ,�-- .........•........................................... (Complete in Triplicaft) Permit No. .�. .l.___-. 1 ........................ .................. ..._ Date Issued ..............•........................................... This Permit Expires 1 Year From Date Issued I Application is hereby made to the San Joaquin Local Health District for a 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: rrzz JOB ADDRESS/LOCATION ....l ...........S..........kft .........(ZT....................CENSUS TRACT Owner's Name Clea - S.Ta<.c. - ................. -•........:....:................Phone 82 .... ..f... ...... Address .. nw ..........I........... ...City ........ --------- --------- ------ A Contractor's Name ----___--------- ............... .License ,# ..r� `�1$ Phone Installation will serve: Residence 54 Apartment)House 0 Commercial OTraller Court 0 i Motel ❑Other .. Number of living units:....1------ Number of bedrooms .-�-------Garbage Grinder --------- Lot Size 1.6 ..-....... ..............---- Water Supply: Public System crud name ....:......... .Private --:..-................................--_.............---....................... 01 Character of soil to a depth of 3 feet: Sand-U Silt❑ Clay -0 Peat 0 Sandy Loam ❑ Clay Loam 0 s Hardpan 0 Adobe 0 Fill M6terial ............ If yes,type (Plot pian, showing,size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage .pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT SEPTIC TANK Size--............. .'i...... Liquid Depth .................... .----- Capacity _----------------- Type _----------------. Material-------------- --•---- No. Compartments ................------ Distance to nearest: Well ....................................Foundation _ Prop. Line LEACHING LINE [ ] No. of Lines ------------------------ Length of each line-----------.-._............. Total Length _--......................... D' Sox Type Filter Material -Depth Filter Material ......:..:........ Distance to nearest: Well .. Foundation - Property Line ........................ SEEPAGE PIT [ l Depth --------------_... Diameter ................ Number _---_-----_---f----- Rock Filled Yes 0 No (] Water Table Depth `- .......(tack Size Distance to nearest: Well ............Foundation --------------------- Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ....................................I Septic Tank (Specify Requirements) ...:......... ......................................................._---•--•• --••••---. _—.-----•----------.'.�.=_. ...... Disposal Field (Specify Requirements) O 0 0►t1---- -0® 1 . L I v� Fee,f - '°'------------------ ------------------------------------------------ --------------:...................----.-.---•-----•----------............................................................................................. (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 Health;District. Herne 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." Signed -----------------__---- Owner * i k By --....----/-7 02 ---------------------------------------------_._... 3itle -- ----------------- -- Of other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---.- t ---------- ---------..-.-............... ------- DATE --A4!774:'—ZS------- -----: BUILDING PERMIT ISSUED .:............ --,------.DATE ........-._............_..................... -- ---•------------------•- ADDITIONAL COMMENTS ---------------__ - ......-----------------•--•---_...._._..-.....•--- ........................... -----------------------• ------I.................... -----------------•--•----.......-------------------------------------- ----- --------------- ............ •.....-- .. ------------------- _ Final Inspect ion lu Date ----- .-r . '_7 -- EH 13 2h 1-68 nev• 5 SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3M