74-645 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR, SANITATION PERMIT ........ ....................:........................... _ Permit No: .��`r.�` zl (Complete in Triplicate) - Date Issued .1..r� �'o?.5:7.zy' This Permit Expires t Year From Dale Issued ' Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein described. This application is made in compliance with County Ordinance No. 544 and existing Rules and Regulations: . / �_._.. ... D`................CENSUS TRACT . _� —��__..... JOB ADDRESS/LOCATION .........�..-t�_ ..1..._.....�......ZA C _ Owner's Name ........ L7 . S�---•----••-•. --•.......................:.... ... ........Phone .................................... Address --..._._... _f. .�. 1..........W....... C ......B D ..... City - ._..... -• •-- _... Phone Contractor's Name �.�/.��::.. - :..License # -------------------- .............................. Installation will serve: Residence partment House 0 Commercial❑Trailer Court 0 Motel ❑Other ---------------------•--------------------- Number of living units:......... Number of bedrooms .. . ._ _....___ ge Grinder . Lot Size ....... .......... I J�}C C, ..Private ❑ Water Supply: Public System and name ... ----------------------------------.................... Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam �- Har dpan ❑ Adobe❑ Fill Material _.Cv- if yes,type --_----------------_-- (Plot plan, 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 seep pit permitted if public sewer is available within 200 feet) it l3 ..,_.._ PACKAGE TREATMENT [ SEPTIC TANK) Size.......,: -�!•-•X. •.�- Liquid Depth .... __.....:. Capacity . Type " b —Com artments ......... Distance to nearest: Well C ----....Foundation ....-� ......••. Prop. Line ..- 1... r _.. Length of each line.-. .....-:---- g LEACHING LINE No. of Lines ....----. -.__. Total Length .._..�. . --••--• e ••De th Filter Material Jt :..:..........'D' Box Type Filter Material ..:..i. d i...... f - �f Distance to nearest: Well _..._ ... Foundation -----1 -------------- Property 'Line .................. [' SEEPAGE PIT [ Depth -----------------_ Diameter ................ Number ...... ............... Rock Filled Yes':❑ No I] r Water Table Depth__ • ....................................Rock Size,....................-•- -,------ d- ----- Y ' .............. Distance to nearest: Well Foundation ---------- --- Prop. Line ................... . REPAIR/ADDITION{Rrev. Sanitation Permit# ........----••......--•----- Date ..........:. .........•--•-.-••-- ) rr Septic Tank {Specify Requirements) ....................------.................•--•--•---.._...._......---•--------•-------•--------•--......__..:..._.......------•----•---•-- Disposal Field {Specify Requirements) ------------- ....... t �. _ __... _,. --------------------•- -------------.......----------..................................------ --------------I......... ...... -•................................................................ --•---------------------- --------•---... .....- (Draw existing and required addition on-rev_er-se-side) I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin t County Ordinances, State Laws, and Rules and Reguiations-f the-San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: i i "I certify a in the perform n of the work for which•this permit is issued, 1 shall not employ any person In such manner as to btV96;,b,_jiectt Wor on's Compensation aws of California." Signed --... .... ..... ... . . ..... .............1..................... Owner By ---------------- --------------------------------- ------.. - - Title ......................................:...•--... ....................... - (if other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ..... _ .:. Q`-.. 'L /�?-�-ZnLkh!U• DATE ...... ._........-- BUILDING PERMIT ISSUED ........................: . t DATE _ -'..._......_... .....---•-•-•-•••• ...... ADDITIONAL COMMENTS -------------!:_ -------_ . . ... . ••-•............. Final Inspection ak� --••-• --•-........Date ...•---F SAN JOAQUIN LOCAL HEALTH DISTRICT 7/723 . '- r u 13 24 1_-AA a-- sou _- --