71-1073 - Laserfiche WebLink

Home Browse Search

FOR,OFFICE USE: APPILIC�ITION FOR SANITATION P1ERMIT y J Permit No .f ------------------- --- f ------ (Complete in Triplicate? 4' - ------------- Date Issued 4 This Permit Expires 1 Year From Date Issued --------------------- permit minstall Application is hereby made to the San thDitricefor No549 a d existing Rules and Regulations. described. This application compliance l h COrdinance ------- CENSUS TRACT S JOB ADDRESS/LOCATION __ ._ -" - - - -------------- ---------- -------------------- : --Phone Owner's Name city -klt '�0 ---------- -----"-------------------------------------- F {Address)-4w ------- --.License # ----- ----------------- Phone --------- =------------------- Contractor's Name Installation will serve: Residence El Apartment House Commercial :[]Trailer Court 10 I { Motel ❑Other ---iCFA' A.-_W_.o � Number of living units!"__-I------ Number of bedrooms -1"-------Garbage Grinder __--- Lot Size --_ - -----_" --- - --- E +�' ----Private Water Supply: Public System and`name ---------------------------------••------- -" --------------------------------- ------ 11 0 clay Peat Sandy Loam ❑ Clay Loam [ICharacter of soil to a depth of 3 feet:. Sand`❑ Silt❑ Y .� ❑ I � Hardpan ❑ Adobe-X Fill Material %`a----- If yes,type ---------------- ----------- 4 Plot Ian showing size of lot,'location of system tri :elation to wells, buildings, etc. must be placed on reverse side.) f 1 p g �t c = NEW INSTALLATION: (No sept c tank or seepage pit permitted if public sewer is available within 240 feet,? I PACKAGE TREATMENT [ ] SEPTIC TAMC [ ] Size-_-------`aOD-�rr_N ---------------- Liquid Depth ---------------- W ;r,_- _ CA Type *�7tC,W� --- Material_L'PN ��=�--- No. Compartments -------•-• Capacity Ld-' Yp r l p '�-0--•------ DistanceIto nearest: Well ____��-�------------------Foundati� ___ �-_------------ Pra Line th --------------- Length of each line------ -- --------- Total Leng - LEACHING LINE [ ] No. of Lines -------� 9 D' Box . -- Type Filter Mater? �- `''-`_Depth Filter Material _-""--��---- 1 ,� 3 Property Line. Distance to nearest: Well ----5p-+----- Foundation __-"i---- i --_ ----------- Rock Filled Yes. No WX g Number __--- -- - �uC-E•P�f"PlT [ l Depth t�". --------- Diameter -------- ----- - - I sVn1� } Rock Size " Water Table Depth "t3NK ---• " # {�'�/►�> -_-_.Foundation.--"M—"----- Prop. Line _ - ----• Distance to nearest: Well ."-yf./1./----�---------------- I Date ----------------------------------1 REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- � x I ------------- , Septic Tank (Specify Requirements) "_-"- ___________ + :-,. : 1 Y Requirements) ---------------= s_ Disposal Field {Specs a u# - ." _--------------- ---.-------------------------------------------------�------------------------------- I..-It kl --------------------------- - -------------------------------------------- I {Draw existing and required addition 6h reverse side) I hereby certify that I have prepared this application and that the work will-lie-clone in accordance with San- Joaquin County Ordinances, State Laws,iond Rules and Regulations of the San Joaquin Local kd-alth.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 object to Workman's Compensation laws of California." owner Signed -=--------------- ------------ -Title - t By ------------------------ (If other than owners ; ��,,,jjj FOR DEPARTMENT USE ONLY DATE ..... r 1- ------ ------------------- APPLICATION ACCEPTED BY ---- ------- -- -- - ---- ----------------------------------------------- - BUILDING PERMIT ISSUED - ` '_`- -"_- _- — _--,-- —_...>,w" , _ ^` ----------- ------ ADDITIONAL O ENTS ---------------- --------------------- -- --------------- ---------- - ---- ----- ----- "�: `' P r. � --------------------- �3 7- s.z✓�f 5 s ff' ----------->n -----m-A—"A �1 �c�` �" ' �'.- -- ----- --- ------------------------------------------------------------"------__--_"_-----------------_----.-------------_--------_---------__----------__---_----_-___-- "_"_--- "�_""-_--"""_--"_ ---___- ----------------•-------- -- ------- --- .Date -------------- _----------- ---------- --------- Final Inspection by: ------------------ " - ------------------------------------------- - - -- - - SAN JOAQUIN LOCAL HEALTH DISTRICT E f{' i� E_ H. 9 1-'68 Rev. 5M w �-