71-228 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. �-- `' -------- -------------- ------ --------------------- i (Complete in Tripl'scate) 77 Date Issued __ '5171 This Permit Expires 1 Year From Date Issued ------ k Application is hereby made tc the San Joaquin Local Heaith 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: F JOB ADDRESS/LOCATION --..��.�I- ---- ----.-�`� "__�r_�G`��_- - ----- ---------- NSUS TRACT --�-----�--------------- 1 ------.Phone _ ----------------------------------- = -` Owner's Name -__. - _ `�- - f City ----------------- Address ---- -- --- - --- -------- --- - License #_o ��'- l "j Phone Contractor's Name --- . '-�=-'-`-"'-i----- .o. ...'.. a Installation will serve., Residence Apartment House❑ Commercial a❑Trailer Court ❑ Motel []Other, `-------------`-------------- � r I` Garbo a Grinder ______21 Lot Size ._ -8110A_ f --- Number of living units:.__ ! i Number of bed oms __ 9 Water Supply: Public System and name ---- -- -...... - -- ------------ Private ! ❑ y Clay Loam Character of soil to a depth of 3 feet: Sand'❑ Silt;❑ Clay ❑ Peat Sand Loam ❑ 1 Y ❑ s Hardpan ❑ Adobe Fill Material ------------ lf,yes,type ------------------ ` (Plot p14, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) ANEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) ` CKAGETREATMENT SEPTIC TANK'[ e ------------ --------------- --_---------- Liquid4.Depth - ------------------.- PA Capacity --------------- Type-------------- �"_ Material'., »--------------- No. Compartments ----------..------••-- � I K s Foundation --- Prop. Line . Distance to nearest: Well "---------------------- ---- ! ! � r LEACHING LINE '' No. ofkLines _ - of each line___-- d Total Length -•- . Depth ,Filter Material __l_ _^ ------------=-- 'D' Box ---- p--- Type Filter Material - Distance to nearest:.Well __" - --_r_ -- Foundation ---- -----------i Property Line -----4�--------•-- 4 ` I ----�' Diameter _� _ -- Number -------- -------------- Rock, Filled Yes Ek No 0 SEEPAGE PIT Depth i__ .-* � I C) '�� ---- ---------- -el -------------Rock Size --o�-�-------- --------------- _,,._ E Water Table Depth _.____ --- 4a-------------------Foundation __ ---------- Prop. Line __--V�y_ .___-•- % Distance to nearest; Well;______�---- - 1 :. -------- --------- - Date -------------------•-------------- REPAIRfADD1TION(Prev. Sanitation Permit# _...----._-----;- t ---------------------- Septic Tank (Specify Requirements) ------------------- ----r------------------------------------------------------ 11 AI f' / Q �� , / rl------------- -------- Disposal Field (Specify Requirements) __� -f ------- - - ------ d----------/-----------Y- '° � � -° = � `------•P�1°�Pi_ ------,� ----------- . - --------------------------- ---------- a- ------C- -- --g--- (Draw existing and required addition on reverse-side) L ` 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: f "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. ' Owner -� Signed -------------------------------------------------------------- ---- Title ----------- - --------------------------------- ----- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY4. ._I.,f' !�Y� r '�� -------------------------------------------- ----------------. DATE _ _'_ _ �.. �.----- ---•- ------- BUILDING PERMIT ISSUED - -----1 ------------------------------------------ ---------- ---DATE ------------- ----------------------------- 'ADDITIONAL COMMENTS ----1-1----------------I-- ------•1---=- - ------------------- ----------------- x ___________________________________________ --------------------- - ____________ '----------------------- f-------------- - ------- .._Date '_ - -'��---------- '- - i Final Inspection by: ;,��.-�.-�---- �-�----- SAN JOAQUIN-LOCAL 'HEALTH DISTRICT a_ E. H. 9 1-'68 Rev. 5M"