74-492 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 9 Z Permit No. lj� ` • - •••• (Complete in Triplicate) Date issued .4-:/.°--ZY, This Permit Expire'%,`-Year From Date issued !......................... _.. _.....__...._. j _ . , ----*- .- -- ion is hereby made to the Stan Joaquin local Health District for a ,permit to construct and install the work herein Applicat o Y described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: :.... ..�.. �_�...��...._....._ EN5U5 TRACT-•�•'. ......._ - ,.• C I -. _.:..... one _ ............................. Owner's Name / �"'rx:.� ........... .. . P Address' �. .�e67 C .P^.,� .. ..cr: ._. C'tY Phone .__. ... _.... Contractor's Name .`} - .... -.._. 'G�Aportment ...................license # ��.e S'• Installation will serve: Residence House Commercial❑Trailer Court A lam_ Motel r7j;Other .............--............................. Number of living units:..---------- Number.of bedroo ms ------------Garbage Grinder ---.---•--.. Lot Size ..__--- ----- .....5--...---. .- iva ❑ Private f Water Supply: Public System nd name ......— - -------- Water -- r 4 "Pegt and Loam ❑ Clay Loam ❑ Character of soil to a depth of 3 feet' Sand'❑ Silt❑ ClCIaY ❑ ❑ y e •-----_---------------- Hardpan C] Adobe C] Fill Material ..._...._... If yes,type Plot Ian, showing size of lot, location of system 4in relation to wells,l id gs, etc. must be placed on reverse side.) { P NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) SEPTIC TANK t ] Sixe.•-••----...---••--••----•..................... Liquid Depth PACKAGE TREA7MEN [ ] l `. Material.............. ... No. Compartments .......__.... ....... Capacity -----------------•- Type p .,. .......-_..... 00 "-Distance to nearest: Well _._-.Z--•-••---••••......--•- _ Foundation ....-•--•--•----• Pro Line----•••.............•-• � LEACHING LINE [ ] No of Lines -.-.----•-----•--•••_;�Length of each line.............. ............. Total Length rI � •-- ial . --•---•. DBox Type Material .---•---•--- -•---De Depth Fitter' Mater ••--• Foundation ......... perty Line,:........................ Distaste to newesWell .....- �{ IV -i --•-----• . No C] SEEPAGE PIT Depth - E • -._.. Diameter --------------• ---- ---- r i �# • ` ` Rock Size ..........:............ Rock Filled Ye's ..... -• Water Table Depth Wel ...............................Distance to nearest _..._Poundal'on Pr p ine Date ....____.. ....................... REPAIR/ADDITION(Prev. Sanitation Pit ) { Septic Tank (Specify Requirements--- i Disposal Field (Specify Requirements) .........................••- / ....................... .... - � n% . • .................. - �� {Draw existing and required addition on reverse side.) z I hereby certify that I have prepared.this application and that the work will.be,done in accordance with San Joaquin State Laws and Rules and Regulations of the Son-Joaquin Local-Health,District. Home owner or iicen. k County Ordinances, sed agents signature certifies the following: I in such manner °`I certify that in the performance of the work for which this permit is issued, I shall not employ any person as to become subject to Workman's Compensation laws of California." �. Signed Title ....................................................Owner ............ ' ............. - r (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ..... ...... . DATE ........ DATE BUILDING PERMIT ISSUED .................... y ADDITIONAL COMMENTS ................•................` -..... - .... .. ---------. .... . ... 7-, . .... ................ - - ----------- -------•-----•-------------- ....... . .... ... 41f ..... !.Date _ ...... ----------------- Final Inspection by: ....... . J_ SAN'JOAQUIN .LOCAL_HEALTH .DISTRICT. .:, _ _ _ — —=— r TM ' w 7/72 3'M