71-258 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: s. ,.. APPLICATION FOR�SAN&ATION PERMIT --------------- ---------t------'�'•------------------ Permit No. (Complete in Triplicate) ----------------------s-------- ---------------------- / 77 ----------fes_-__-.__________________:--_----_-----_ This Permit Expires 1 Year From Date Issued Date 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 com fiance with County Or mance No. 549 and existing Rules and Regulations: ��to /7iJ06 ADDRESS/LOCATION ,C.l ____--_. _ . � NSUS TRACT �`___ Owner's Name ------- ----- _ - --Phone._.. .77-----7-9cf.-----` Gress ` - ----------. City - - --------- _ on tor's Name ------------ ----- -------�`-� License # / �� Phone _.. r r0-Installation will serve: Residence ❑ Apartment House❑ Commercial :❑Trailer Court l❑ *Motel ❑ Other ------------- --- , ". �j ter/ �. Number of living units:-------/_' Number of bedrooms-7-7 .Gam rbage Grinder ____.____ Lot�Siie __7_L_x____7:`E.0 Water Supply: Public System and:name ---------------`_---_----------- ----fl 1-- ------------------•-------- ------- Private i - i Character of soil to a depth of 3 feet: Sand❑^-,Silt C] Clay ❑ Peat❑ Sandy Loam [] Clay Loam ❑ Hardpan ❑ Adobe Fill Material If-yes type --------------------------- (Plot _____________ _(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 per if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TA;K0 Size__________ _____x___ ._______ _____---- Liquid Depth ._ . Capacity _ow ____�; Typew_=_._ _,)M Material_.!7 -U__ No. �Compartments ~' ---- ----------- r _F1.Sf ---------- Foundation ` Prop. Line to nearest: Well ______ v_ __ _____ LEACHING LINE No. of Lines Len th of each line:_____ _�i2___'. Q Ta Distance ,,��-- -- g p � �` # Total Length ---��---------•-•-- D' Box _. a___ TypeTFi'Iter .Material --------------------Depth Filter Material ___f_ _ _________________•__--• ' Distance to net est.;Well. --�-L)-----------.Founidation-___L �1•- ______ Property Line __- _ ............. t� Number -f - SEEPAGE'PIT [� Depth _:--_��.______ biometer .�,� U- -___: Rock Filled Yes 2C No ) Water Table Depth --------- I----------------------------------Rock Size f �' �- ------- 1 i [ j tliy Distance to nearest: Well ----- ----------------------------------Foundation -------!----- -----. Prop. Line ................... ... J REPAIR/ADDITION(Prev. Sanitation Permit# __E---------I--------------------------------- Date ____________________!_____ _______} l Septic Tank (Specify Requirements) ----------------------------- ------ =-----------•-- - •---------------------------- 3 r� -- I------------------------- .. �--------- ------ Disposal Field [Specify Requirements) ____________ _ _____________-_____________.._______________ ------ -- ---z+4� ------- ------------------------- - Fc:-----------------------------------------•-------------------------------------------------------------------------------------------- ! J(Drav✓existing amid required addition on reverse side) I ! 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: 1 "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed --- -- ----/- -- ----- --------- ------ - t Owner By ------- - ---------f _ --------------------------------- -Title ---- -------- (If other th wner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------- (- - ---------. DATE _-..--- -- L "7 - -- - -- - -- ----- ------- - -- BUILDING PERMIT ISSUED t - ---------------------------------------------- DATE ------------------------------------- ADDITIONAL COMME f -------------------------------- -------------- ---------------------------- ----- -------------------------------------------------------- -------------------------------------------------------- FinalInspection by: ----------------------------------------- ------------------------------------------------.Date ----------------- --------------- ---------- SAN JOAQUIN LOCAL HEALTH DI TRICT 16-13 -72 ✓ �rS.T• G E. H. 9 1-'6a Rev. 5M 49.% 9 ` '`