75-955 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE. ...........I........... APPLICATION FOR SANITATION PERMIT (Complete In Triplicate) Permit No. ..................... ...............I..................... _3� ;2 Dote lssued .!��.......... •........................................................ This Permit Expires I Year From Dot*Issued Application is hereby made to the Son Joaquin Local Health District for a permit to construct and install the work herein described. this application is Made in compliance with Co t Ordinance No. 549 and existing Rules and Regulations:p f :h n J013 ADDRESS/1.0 ION rv�23. __ ..... 0 r r -3 -7, .................... ...CENSUS TRACT ......... ....... Owner's Name 4T' ..... . ...... ..,..Phone .. ....... ...... Addresscity C�AV ...... ... 4P .1 .; ........... ......... ..........� ........... —............I............. Contractor's No .... -•------'------- .. ..... --__---,License Phone ..............I........ Installation will serve: Residence 0 Apartment Houseo Commercial OTraller Court C] Motel 0 Other Number of living units:._.._.. Number of bedrooms ---Garbage Grinder..... ....... Lot Size ............................I.............. Water Supply. Public System and name ........................ ........................................ .......................... ........... .....PrIva te Character of soil to a depth of 3 feet: Sand Clay [I Peat C-] Sandy Loom 0 Clay Loam 0 Hardpong#" AdobeO Fillm6terial ............ If yes,type ............... ............ (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 permitted If public sewer is available within 200 feet,) PACKAGE TREATMENT f ] SEPTIC TANK Size....... ...... I ---- Liquid Depth ....___._I.... Capacity ---------------_--- Type _------------------ Material......------------_. No. Compartments ...................... tow Distancel to nearest: Well _.,...............................Foundation-_.................. .1 - Prop. Line .............--•---•-- LEACHING LINE No. of Lines --------------------- Length of each line------- ..............I...... Total Length ............................ V Box' ........... Type Filter Material . ............Depth Filter Material ............................................ Distant ejo nearest: Well ........................%.F;undation _.......... Property Line ....-.................. SEEPAGE PIT Depth -1................- Diameter -----------•---- -Number-.777'-�.�.............. .Rock Filled Yes'[] Water Table Depth -------------------:............................Rock Size ..--•--••---•-........._ Oy Distance to nearest.. Well ................. -----------Foundation e.----.•_._......_... Prop. Line .............• ......... REPAIR/ADDITION(Prev. Sanitation!Permit# .......... -------------------------- Date ........ ................ ....... Septic Tank (Specify Requirementsl. _...----------- ........... ......................_*------ ................ ....................J- ---------;,t....... ........ ...... Disposal Field (Specify Requiremye ts) ......... ----------------- ........... . ------404 7w%.� eV -------------- ............... ................----------- --------------------- ----------------------------11--------------- ......................... ...... ...................................... ....................... ] (Draw existing and required addition on reverse side) I -hereby certify that I have prepared this application and that the work will be done In accordance with Son Joaquin County Ordinances, State Laws,',ancl Rules and Regulations of the Son Joaquin Local Health,Distdct. Home owner or licew sed agents signature certifies the'f I allowing: I certify that in the performanc6.of the work for which this permit Is issued, I shall novemplay any person In such manner as to become subject to Workm . Compensation laws of California.- Signed --------------------------- ---- --- - -- ----------- -- --- - ------ -- ------------- Owner -- By --------------------- tie 2.,*1.. ..... . . .... ...... .. (if other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ...... -------------- -------- BUILDING PERMIT ISSUED ._-7 7----------.�j.-:-------------------- ..... DATE ....... ..............................................*------------------------------------- __....---DATE .... ......... ADDITIONAL COMMENTS ----- ................... ------------------------------------ ------------------ ........................ ........... ........................ - -------------------------- ------------------------------------------------- ...... ----------- ------------ --------------- - -- ------------------ ----- ...........I... ................ .......... ------ ---------------------------I--------------I............................ ---------------------------------- ------------ �:/_/411"?---------------- --------------------------------- Final Inspection by: ------------- --------------------------------------------I---------------- ------------------------------------------ ---------------I------------------------------------ ----------- .................Date EH 13 2h 1-68 11pV. 5 M SAN JOAQUIN LOCAL HEALTH. DISTRICT 8/7 3M