76-869 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PEIt11A1�' -. _....... .. Permit No. .7 (Conplefe In Triplicatel ....................................................... tq'Date Issued ld ........................ This Permit Expires 1 Year From Date Issued : a Application is hereby made to the San Joaquin Local Health District'for alperrrr t)to,construct and install the work herein described. This application is made In compliance with County_Ordinance N 549 dnd existing Rules and Regulations f *w JOB ADDRESS/LOC TION'7.. _ ' . ..CENSUS TRACT ....... .. ......:... _ Owner's Name ... .....� yJ :�. :..._........ 1 . .3.x' . ..... .............. �...__.: ....=1'#tone'' • ' • Address ......S....1A6b_t"�: Contractor's Name .._ _l1Si ..........:..... .................................................License # Phone"�►-�r7--'s Installation will serve: Residence)(Apartment Housed Comme�•cial ]Trailer Court M t 1.❑Other/ 1 - � s W - Number of living units ------ Number of bedrooms .c�L---Garb-age Grinder __ Lot Size ____ -. --. 9k,(.-.is ........... Water Supply: Public System and name ` -- �- �'k*- ---------------•----•---••----•....:Private z .... - .............• HCl-- Character of soil to a depth of�3 feet: Sand 0 silt El. Clay p Peat❑ Sandy Loam ❑ Clay Loam Hardpan, Adobe 0 Fill Materlol ............. If yes,type t ............ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on.reverse side.) i NEW INSTALLATION:.i '(No septic tank-.or seepage pit permitted if public sewer is available within 200 feet,), --�, ,. �_ ... r� PACKAGE TREATMENT { ] SEPTIC TANK r � `" � Siie:I....�..�..ssrGt- ?---`!- ,t� Liquid Depth '---- Cap city -` (?t _JType .. •• MaterialNo. TCompartments -•-V4--------------- �,; �. Distance to nearest: Well' ( .... --.__...._•..Foundation .._m •_____ Prop. Line Q. :.-•.6' LEACHWG LINE [ j No. of Lines -"4-'_�,_.-_______- Length of each ,tine.__ (. .. Total Length {. -9 ••..--- 'D' ,Box Type Filter Material .� '!-��; i epth Filter Material ...� �'_- ••-•P !..rl....._.._ --.Distance-to nearest:Weir•- ,.: _-Foundation ---/..t . •_ .7 ... Property Line ....__4�.... .._l.._.. fl SEEPAGE PIT J Depth ._f_ .......... Diamet9kT?11_0_. Number .___._�2»........... Rock Filled 'Yes Er 'No 0 Water Table Depth ................................................Rock Size ------= . C Distance to nearest: Well ....� S___" ..........foundation lJo -: Prop. Line-.5�h.. •••[., REPMR/ADDITION Wrev. Sanitation Permit# •••_ ........................................ Date ..........................,....... ). • Septic Tank (Specify Requiremeritsl -------------_---- .....................----•.....................•---------._..._.._....-....=---------....•............._...------ Disposal. Field (Specify Requirements} -------------------------------------------------------------------------- ---------- ----....---------------..__....-•••............. � t ---------------------------------------------------- - (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. 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 taws of California." _ Signed ................................ ._------------- •.... - ---------------------- Owner t BY ..._.. ��$�?...&—w-}��1t title -- . (If other than owner) f FOR DEPARTMENT USE ONLY. f APPLICATION ACCEPTED BY ------------------------ --------------- - -.._. DATE Cf. _. ...: :------- E BUILDING' PERMIT ISSUED ..... .....:.............. ...� -------..._._ DAT ADDITIONAL COMMENT _ le e ,. , ---------------- .............. Final Inspection 6Y �" ------ -•-•-----------•------._ ..._.._.Date /.Q. ../. - . ER 13 24 `� V. 5 SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3M k