74-752 - Laserfiche WebLink

Home Browse Search

l }} FOR OFFICE USE: 9 1Al'PI.ICATlO FOR 5ANITATION PERMIT ------ ....................... Permit No. -..-. (Complete in Triplicate) - �- . ........ ..... .. This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to t e San Joaquin Local Health District for a permit to construct and install the work herein described. This application is co liance with County Ordinance No. 549 and existing Rules and Regulations: /� , M,Scc�C� •f- IJOB ADDRESS/LOCATi GU r. g7f1/doP.IQA�.... . 1/,',T'�iY.�C�.--- ------��r e�a----?! .d..CENSUS TRACT ....----•-•--•............ Owner's Name !.'.L FnIT .. . . . . ... .... .��.. -c;r.T",--•-----------.,.... -•-•--------............ ----.Phone .........................I.......... +!., .!�4{^!ee. �ny. .....1.�.2�.11.L1�±[or�.-fir..... City ..., To.Grt-ro.,� ._........................... .. .............. Address hJoC�P. - Contractor's Name ..'Q. ..`L�.A�.r? tZ�S.�l.. -SQ.ti4S-..*.x --- -----.License # ......... Phone .�1�66�1 .Q7----- Instailation will serve: Residence❑ Apartment House❑ Commercial ❑Trailer Court 0 Motel Other . 'it0_.e...q.77A7.2eV--...C?,.sr, 46/-, r7 � Number of living units:.......... . Number of bedrooms ..----.....Garbage Grinder .- Lot Size ... F........._............... Water Supply: Public System and name ...................___-----------------A__.......... .-:..---.............- .................... _-Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Ciay.❑• Peat❑ Sandy Loam It_ Clay loam ❑ aHardpon ❑ Adobe ❑ Fill Material If yes,type ............................ (Plot plan, showing size of-lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) l i NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK Size.----- ---------------------- ..•. . Liquid Depth .. .................. Capacity .)'200 gnls Type . ............. Materiol.Obt&A-LG..._ No. Compartments --- ---------_-_— Distance to nearest: Well -----------I---Foundation ...` ........... Prop. Line .. ............r LEACHING LINEVJ No. of Lines Length of each line length ....447-0..- 'D' Box Type Filter Material Depth Filter Material .../- - ------------------------.......... Distance to nearest:-Well .- ....._.... Foundation _../Q.............. Property Line ......./G.f....-- SEEPAGE PIT [ ) Depth Diameter ................ Number`....... Rock Filled Yes ❑ No ❑ Water Table Depth ............ .........................-.........Rock Size _-_------------------------- Distance _----•-------- ------Distance to nearest: Well --------_--------------_-- .....Foundation ................---. Prop. Line -----------..---..---- REPAIR/ADDITION(Prev. Sanitation,Permit# _.------ : _-......................_. Date .-.------_--------•--•-.----------) Septic Tank (Specify Requirements)�.... ........ ................... •------------ ------ ------...............-.. ................. -------- p p t � - Disposal Field (Specify Requirements) ------------------------------------- ......------... ..................... .-..-.............................- .............. -.....................�--- ------ ---.... . ....... --- ... ........--------------.... . .. ------....... -------•--- ---- ---- ... ----- ......... ................... ................ ... : ---...... .... I(Draw existing and required addition on reverse side) J P I hereby certify that l 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 Son Joaquin Local Health 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, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." kSigned . a.� .►_ :fis.t s N ..5'.A.nr.� ...........+9wrTerr SY ... -- •.- -.... .�- �.c�. a-c�---- -- Title . .. ...... . ........... ..................... other than ov er�, 4-v FOR DEPARTMENT USE ONLY I , APPLICATION ACCEPTED ._.BY�`.. � .._.�.. .......... .. -... ........ ----------------- DATE ....v4t" ------------ BUILDING PERMIT ISSUED .. ..... ..... ..... -........DATE ..................•--- ---------- ADDITIONAL COMMENTS ......_._.._.-..._.......-_ '' _....... ..................................... ............ -- ____................. -•-------• ........ s-- ------- -- ------------ -------• . - -------. . ...-.. ---.--- -- ------ ----.......... l ------- Date ._ -.--------------- ----- ` �...�. ........ ..- ....._. Final Inspection by: ... SAN JOAQUIN LOCAL-HEALTH DISTRICT 7/72 3 21113 e .� , ��n c_.. �ru ....