76-375 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ..................... 7�-_3 7 s (Complete In Triplicate!_.;.,K- Permit No. This Permit Expires 1 Year Froin bate Issued . Pat*Issued ... ....... Application is hereby made to the San Joaquin Local Health District for r ' described. This application is mode in compliance ith County Ordina ce No. 549 and axiermit to s ng. Rules�t and tand Regulotiol the work na 61n JOB ADDRESS/LOCATION .........- -- a�� CENSUS TRACT yam, Owner's Name ..... . .................................... �-j- Phone � ' Address _.._.._ � ............... ...._.._....... .................... Contractor's Name city Eicense .,7��f'"-; y......... Phone Installation will serve: Residence - Apartment House Commercial]]Trailer Court Motel ---' ❑Other { Number of living units:_:.__( Number of bedrooms�...._Garboge I Water Su Grinder 1rI . Lot Size . i ^ Supply: Public System; and narne // ..._-- ---•-•- ..Private Chcracter of soil too depth of.3 feet Sand:[] S€ItQ C#a -- p�t� ..-.-��.-..- .••- - ,. Y O ❑ _ Sandy Loam r _3 1 Clay Loam ]j - x Hardpan p'`, Adobe FillNl#aerial. ,,/ (Plot I ✓" `i€Ye+�type Pan, showing size of lot, location of system iri` lotion to wells, buildings, etc. must be placed on reverse side.) i NEW INSTALLATION:N: INa septic'tank'-or spp --g p ee cr a 1t'- ermitted If public sewer is available within 200 feet,I PACKAGE TREATMENT I ] SEPTIC TANK ] Size ` .............. Capacity, _ } Liquid 'Depth TypeMdteria)_._..= --.... . o. Ca men .................... ly mart Distance to nearest: Well .. � is LEACHING Een th of each line-Foundation......-.----••_-•.. . ......... LINE [ ] No. of.Lines t.,_.-:.. ............. 'N, - Prop. Line ,_ �J 9 'D' Bdx':i......._.• ,TYPe Filter Wterial - .... - Total Length ��rrII r .... Depth .Filter Material Distance to nearest; Well -------- _ . . . f SEEPAGE PIT { Depth foundation _ Property Llfie ; .... 1 'diameter _ ......... ..... �Nuranbet ---. � ,- ' .. ..... . ,Rock 'Filled Yes-'O No Water Table Depth/f .- a .-Rock Size « . Distance to nearest: Well . --- ._. --•- --- ----••---.Foundation .---•---•• --•--•---RPAIR/ADDITION(Prev. SanfatioPerm;! A ` Prop. Line . .............. -� .- _ _-- - ------ ••----.. Bate , Septic Tank {Specify Requirements) Disposal FieldS eci ,/..: ..... ..... ( p fy Requirements) ........ _ r =-_.... f� . . ------ Y certify (Draw existingand required addition on reverser`. _:_,-•-------•---- _...........'..........•__.... prepared --q....---- --.._-............. side! � •# •; 1 hereb cern that I have re ared this application and thatthe work wil# be dans in'accordance with San' Jaergtrin ' County Ordinances, State Laws, and Rules and Regulations of the San JoaquinAacal Heatth:Dis sed agents signature certifies the following- "I Hance owner or peace. "I certify that in the performance of the work for which this permit is lssue;� Vshall not employ' f as to become subject,.#o Workman's Comi,pensation laws of California." r Y person in such manner . an Signed -------- �- Owner. ---------------- BY (lf other an owner) ----- xitle _%- --- F _. ___..............r.-•_ FOR DEPARTMENT USE ONLY APPLICATION AC PTED 8Y .__ _ _________________________•---.__. ------- __.__._._._ - d BUILDING PERMIT ISSUED .---...---•--------_-- DATE ADDITIONAL COMMENTS ..--------•-------�- ' -----••------------------=---------------- -------- -- . -------------- ..........DATE ., •----- .. . .: t. .t * .k . .� - ,- - -------.--------•--......---•-...._._...--•---- ------- .... ... ....Final Inspection by: . .._._ . EH 13 -68 Rev. � Date .. . .---................. k SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3M