77-312 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT _ (Complete to Tripliearo) Permit Na. ..................... _S fid';77 ............................... This Permit Expires ] Year From Date Issued Date Issued •--• 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: JOB ADDRESS/LOCATION ......6.791 ,..L ve Oak Rd, ................ ..CENSUS TRACT Owner's Name ..___c�arles F. & &rlene R. Stocker phone 36g-1'7$7 ........ .........-- Address ...Saame_-as-__abQvq.................. City Lodi (County) ------------------------------------•....---- -----...........................-...._.....-•---•---.-..................---- Contractor's Name Self .........License # .. Phone Installation will serve: Residence®Apartment HouserCommercial OTraller Court 1❑ Motel❑Other......................................... .. Number of living units:............ Number of bedrooms __-four.Garbage Grinder .Alone.._ Lot Size ...1._99_Zr.0.a............... Water Supply: Public System and name ..------_----_---_ ..........Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam o Clay Loam a Hardpan❑ Adobe p 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.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) 6 PACKAGE TREATMENT SEPTIC TANK Size....................................... Liquid Depth .....--_--------•--_---A Capacity ----------•-•••----- Type ----------- ........ Material............---_---- No. Compartments ...................... Distance to nearest: Well ....................................Foundation ...................... Prop. Line ...................... LEACHING LINE [ No. of Lines ------------------------ Length of each line............................ Total Length 'D' Box ........_... Type Filter Material ....................Depth Filter Material ........-...................................Ir Distance to nearest: Well •----.-----__--_------ Foundation ............. • C _ ...-•---. Property Line ........................P SEEPAGE PIT [ I Depth ----25!--------- Diameter ...... Number ......2.................... Rock Filled Yes [!9 No C] Repair Water Table Depth ...............Rock Size Distance to nearest: Well ...100_i._p1.us-................Foundation I-........ Prop. Line ..50-.&-.60-1.... REPAIR/ADDITION(Prev. Sanitation Permit# ..........._.................... ........ Date .................................. Septic Tank {Specify Requirements) . --•------- ............ .................................................. --------.................. Disposal Field (Specify Requirements) -----•-- ............---........................................................................ ." ------------------------------------- -- ---------•--••----------------.-----...._.....----• ................ ................................................................ (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. Homeowner 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 By --------•------- ---------- ---------------------------------"-------------------------------•--- ----- Title (if other thanowner) R DEPARTMENT USE ONLY ' APPLICATION ACCEPTED BY ...... __--"-- -- _ 77 77DATE • : BUILDING PERMIT ISSUED --------- ---- -----•- ....-•--- DATE ..- ------------ ............... ADDITIONAL COMMENTS ----------------- ------------- ------------ --------------•-------- ------- -----------------------_ ------------------------- ------- 1=inai Inspection b ...... ....... .. .......Date -..f.J.f EH 13 2h 1-68 Rev. SA J AQUIN LOCAL HEALTH DISTRICT 8/73M