73-778 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FQ.R SANITATION PERMIT 3.0 73-77o4' (Complete in Triplicate) Permit No. ..................... ........... This Permit Expires 1 Year From Date Issued Date Issued .- Application ssued ._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. 544 and existing Rules and Regulations: JOB ADDRESS/LOCATION ......__1€336-_-l_ant6ZUZna_.St......................................................CENSUS TRACT ..............:...... ..... Owner's Name ...r., Kehano - Phone _._463m8,80.5. AddressS TTI?..._...._.. ........................... City ---St-k .............................................................. Contractor's Name .-Bl-ackard-'--s---Sap.ti-c...Tan.k............................License # ....M95.1..... Phone .463.!:7.Q4B........ Installation will serve: Residence n Apartment House❑ Commercial "❑Trailer Court i❑ Motel ❑Other ............... ........................... 9 �s Number of living units:._-....... Number of bedrooms .......-_.Garbage Grinder ...... Lot Size .. .......... Water Supply: Public System and name _.... -------------------- City......................................................................Private ❑ Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam Hardpan ❑ Adobe® Fill Material -.-_-.____._ If yes,type --------------______________ (Plot pian, showing size of lot, location ofsystem 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,) PACKAGE TREATMENT } SEPTIC TANK-[ ] Size....-......------------------------_.......... Liquid Depth ..........................O Capacity --------------_ ... Type .................... Material!----_--------------- No. Compartments .......... ........... Distance to nearest: Well -.---. ............. ..Foundation Prop. Line ...................... LEACHING LINE O No. of Lines ------....7............. Length of each line-------40..'.......------- Total Length ......�a.�._....______._.Z 'D' Box ---I------- Type Filter Material ..._2!.1...........Depth Filter Material ...._.�9............... ................3 Distance to nearest: Well ....... Foundation ---._U.'_......... Property line ..........1...... SEEPAGE PIT Depth ....... Diameter -------4.821.. Number _..___.._.�................ Rack Filled Yes No ❑ { Water Table Depth.---------90.1•..................... ---------Rock Size ................................ Distance to nearest: Foundation ...20.'__.__..... Prop. Line ... REPAIR/ADDITION(Prev. Sgnitation'Permit# ............................................. Date .................................. Septic Tank (Specify Requirements) ..................... ------------------•--•-•••--•• ...................................___..................................... F' Disposal Field (Specify Requirements) ........................... 'P�kC_1...Une-_.&----(_I�...P.it_.�•$':xz +................ --------------------**----------------I.. —-------------------------------------------- - -.... ----------------------•--...----------------------- .......... --------••------......................... _.. . .... (Draw existing_ond 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 laws of California." Signed •------•--• ...................................................... ...........................: Owner By ....... .....: - r z +� Title C y an o (if other than owner) FO DEP TMENT USE ONLY • t APPLICATION ACCEPTED BY .. • - ......••--•----. .. .... DATE1.`--- BUILDINGPERMIT ISSUED ................... •...-............--•.------•------••-•--------•-_.. .......___...-- --.........DATE ........................................... ADDITIONAL COMMENTS ...---•............................................................:...............•---•_.........__.__...------.......------------.._..._...._............._... ---•--------.....-----•---._. ........ . Final Inspection b c _...`� .............. p y: ..- ----- - •-• - --- ---••--••.......................................Date .........._........................... •--... SAN JOAQUIN LOCAL HEALTH DISTRICT E. H.13 24 1.'68-Rev. 5M - 7/723 ,14