75-818 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ! .............. . . APPLICATION FOR SANITATION PERMIT (Complete In Triplicate) Permit No. ... 5~ /....... -'-N -........j This Permit Expires t Year From Dot*Issued Date Issued�Y............. Applieafiors herey mNe- o" fie San Joaquin Local Health District for a permit to construct and Install the work herein described. This application is made in compliance wit3 h County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION �� n � .-S'-,r� /j�f�,�'l�__..o.�oU ....CENSUS TRACT .....................:.... F Owner's Name .d _..L� . -�5...."_........--•............................---•-•----..--- ......-........ ....................Phone . ' Address 203.;t ....... .4G .._./3f2 .................. City T. ................... Contractor's Name ... q.W./Y? ...a -"........_. ....License # Phone fnstafla on will serve:( Residence g Apartment House Commercial oTrailer Court 0 'y w' Motel Q Other................. .......................... Al� Number f living , ' o units•-.----_--_-- Number of bedrooms ......----.-Garbage Grinder ---._....... Lot Size ��......�...��„�.��.-'....-.... Water Supply: t- PP Y= Public System and name ........................... ...._.----•--- ••-- ......•-- Pr va i to i —TICharacter of soil to a depth of 3 feet: Sand ] -Silt pClayPeat[]_ Sandy Loom C y Loam Qom_ . - r Hardpan Adobe-10 Fill Material ............ If yea,typeT- . ..... ......(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 to k or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT SEPTIC TANK .. Liquid De th ..... Size... �3 q p Capacity 0-U_------�Type � .' � a erialF..... ton -_ No. Compartments .......�€ ... Distance to nearest: Well ��-p r op, Line . .. 1.#. .... �' LEACHING LINE No. of Lines .": _. - " Le^ th of each fine_._.. 6 l� r g .Z ._ Total Length (1 4 # 'D' Box .X-�_"- TypelFilter Mater ail�_�_..E�'`G�f}epth .Filter Material _...._...��.._....._. � -- - Distance to nearest: Well �. ---- Foundation Foundation ..__� . ........ Property Line .- '....: SEEPAGE PIT Depth _A. _a._°'J-- Diamete- --` - �'_----- Number .__ ----- Rock Filled Yes. ] No I[ Water Fable Depth '.- ....... ...........Rock Size -----•••................:..:.. Distance to nearest:Well --------------...........Foundation.. Prop. f6 . ... REPAIR/ADDITION(Prev. Sanitation Permit# ...... •------------------------------- Date .__.....__......._................I # � � . Septic Tdnk (Specify Requirements .__...I...........:.. ---._......... -----------...-----•------•--•--...........---•-----'--....-•••--...._................ Disposal Field (Specify Requirements)..........:........................._,------------------------------------------------------------ t ---------------•-•----------------------------:-"'" . "-••---- ....... - ----------------------------- ----------- _.._... .............................. ... .'~•�= - --~� (Draw existing and required addition-on reverse side} I .hereby certify that I have prepared this application and that 1he waikwwllll_:be-done. In accordance with Son Joaquin i County Ordinances, State Laws, and Rules and Regulations of the'Sbn Joaquin tocol Walth;District. Home owner or licew � sed agents signature certifies the following: 1 "I certify that in the performance of the work for which this permit is issved,,i shall not employ any person in such manner as to 6e e s -ect to Workman' Compensation laws of California." Signed --- rC<CI_. _ t -•--------- - ---' . Owner By --------I-------------- ------- -•--- Title _------•------- (If other than owner( t <, APPLICATION ACCEPTED BY ___ "..". - -. - DEPARTMENT USE ONLY �^ -----. D4TE-,/4._.._-16-7. .............. �i3UILDING PERMIT ISSUED - - - -----------•--------�?�! � "-•-- DATE ........ -'---"- ADDITIONAL COMMENTS ----- ____ ____ _ ________ ____ -----------------------------------------------". ._ 1 % , - I ___ ___ ______ _______________________________________________________________ _ Final Inspection by: ............. -- *'pate EH 13 2h 1-68 Rev. SAN JOAQUIN tOCAL HEALTH DISTRICT 3M Xa, i