76-1069 - Laserfiche WebLink

Home Browse Search

POR OFFICE USE: APPLICATION FOR SANITAT110N- PERM Permit (Cam plete'in Triplicate) This Perms►Expires 1 Year From Date Issued Date Issued/..�. ._::�� Application is hereby made to the San Joaquin Local Health District f r 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: :. JOB ADDRESS/LOCATION ........................;....CENSUS TRACT .................. .... 6 � . Owner's Name 4...........� /. _ Phone Z U ,- k Address . . ........... ...-..1...490 6_•- -•.:..._... .. ._ ' ..."�.�y_................. City .... E Contractor's Name ...................:. ................License # Phone W.6. 7,,6.0...7........ installation will. serve: Residence%Apartment House Commercial'OTrailer Court 0 I 'Motel ❑Other ......-.- ................................. Number of living units:_......-. Number of bedrooms ....?7......Garbage Grinder ............ Lot Size ..7.7.....•••••.••...... Water Supply: Public System and name ....:....::........:................f......•.......... ............ .................................::.....Private ❑ Character of soil to a depth of 3 feet: Sand o Silt Q Clay.-p-=--Peat Q -Sandy-toam,0. _Clay Loam Q Hardpan.q Adobe Fill Material ............ if yes,type ............... ............ , p� (Plot plan, showing size of lot, locatiori of system in relation to wells, buildings, etc. must be placed-on reverse side.) �1 NEW INSTALLATION: INo septic tank of seepage pit permitted if public sewer.is available within 240 feet,l k PACKAGE TREATMENT ( ] `-'SEPTIC TANK Size.... . Liquid Depth ... `F L............. f Capacity 0 - Type .4 ----- Material...�r No. Compartments—._.�.��_-._--.. Distance.to nearest: Well ....................................Foundation .....,l..Q-............Prop. Line ... ............. LEACHING LINE No. of Lines --------1------------- Length of each line------- ............ Total Length ....�( ................. 'D' Box .......�Type Filter Material ... . . ...........Depth Filter Material ..-......I..................... . Distance to nearest: Well .:----.._........... Foundation ---...�.d............. Property Line ......----........ ' r C rt : SEEPAGE PIT kQ Depth ---��___..---- Diameter ........ Number ._..__./.................... Rock Filled Yes �`} No Q Water Table Depth .......I— ................................ x _ Distance to nearest: Well ....._ ..foundation .._/Q_...._ Prop. Line REPAIR/ADDITION(Prov. Sanitation°Permit ................ .':. ...:.... - } �.` I � .......... Date Septic Tank {Specify Requirement's) ' -� ,.,�_.I ; .�. .. ..5 ... .. f -_Disposal Field (Specify 'Requirements) - -:-- (� .._.... res-rt-t•2.......•................-----............... '} t -----------• ....__._ ------------------------------------------------------------------....: ------------------ _..... ..........................................I.......... ........................ ..... (Draw existing and re `uired'addition on reverse side) r 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 Heal&District. Home.owner or Ilcee- sed agents signature certifies the following: ` i "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 Campensation.laws of California." Signed ------------ -----J_t ------- ------------ - Owner BY --------- Jitle - (lf othwners ¢. FOR DEPARTMENT U5 ONLY 4 APPLICATION ACCEPTED BY ....... ....... --•-----• ._. DATE�..;l.a.mZ17-74---- ..,.---- :.. BUILDING PERMIT ISSUED -----•---• .................... ••---- ••---•------------•• -----... --- •-- -------....---DATE ................,.............. iADDITIONAL COMMENTS --------- ---.•-----•---•-•-----. .... ....................................................... .................................... ' ------------------------------------------------------ ---•---_----.... ----------- ; ................ --- ---------------------._.._.............. ------------•------------------ ------------:- :.�.. --.r. ._.._......-•--------------......._...--------.._.._....... --- -- -- ---- `:.._-._.... = - ---------- -- --- ........ ..._. _ y final Inspection by: ..� ...._... :..: ©ate ...... ....... EH 13 24 1-68 Rbv.. SAN�JOA4Ul LOCAL HEALTH DISTRICT 8/7!s 3M �a �3