77-572 - Laserfiche WebLink

Home Browse Search

g FOR OFFICE USES APPLICATION FOR SANITATION PERMIT " ....................................................... (Complete lot Triplicate) - Permit No. ..7 .........�...:r-.:2��.��.:"" .. � �. _..-.__- � ...Date lasusd :-�=��: ..........................................I............... this Permit Expires.t Year 6rom Dais issued F Application is hereby made to the San Joaquin local Health District for a permit' to constnid and install the work ;herein described. This application Is made In compliance with County.Ordinance No. 549•�and existing Rules and Regulations: IN JOB ADDRESS/IOCATI �l..S/. t- . . ....X •.�. CENSUS TRACP ......... ............ Owner's Na e . . .. ---. ... . . . s ......................... '� ne .................................... Address ..../0,_ ••r:/•.•-•� e--- �C-=-.......City _ .. .................. ..-....... q Contractor's No ..N ..- !t...4&..LicenseCI. .7-7.. Ph*no Installation will serve: Residence&Apartment House❑ Commercial❑Troller Court__. , Motel❑Other 4 Number of linin units:_. Number of rooms .. .. Gorba Gri der , g ..... ::. lot Slxe ..... . .................... ....... Water Supply, Public System and name - -- -- ... ..............„___..................._ . .....Prt ate, Character of soil too depth of 3 feet: Sand o Silt❑ Clay ❑ Peat❑ Sandy loam ❑ day loam ❑ i Hardpan❑ Adobe Fill Material ............If yes.type.............. ........... . . l !Plot plan,r�,showing of"lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) .r NEW INSTALLATION: (No septic tank or seepage pit perp~ if.public sewer is available within-200 feet,[ 0 PACKAGE TREATMENT [ J SEPTIC TANK I j�/S 1xe .............................................. Liquid�-0 ........epth ....,..:..........� Capacity .................... Type .................... Material...................... No. Compartments .............. ---1 Distance to nearest: Well ....................................Foundation ....... t..:-...... Prop. Line .............. . .Ir LEACHING LINE No. of Lines .-.....1............ length of a ch line...._ :rf...:... Toto I-L n tis �1 ............... •. 'D' Box .. .. Type Filter Material / ..Depth Filter Motorial , ................................ ... �� .�... Foundation .. .1.:.... Property lino .. ' 'g . , Distance to nearest: Well . ......... ..... SEEPAGE PIT Depth Diameter ........ Number .... ................... Rock-Filled Yes No C3.7 Water Table Depth ...... ., .....................Rock Size ... ..` r . ....... a , Distance to nearest: Well ....Z41.a_......................Foundation ....: i ... , Prop. Line ...d�............... , REPAIR/ADDITION[Prov. Sanitation Permit 0 ........... ..I..........__.......__..__. Date . .. .. ..............:...I r Septic Tank (Specify Requirements) .............. .... ... .... ......: :..... Disposal Field (Specify Requirements) - •--- .. .� ---.�,� �+ . . . , ' ....................................... _.... .... .. .., .... 1T. ,�- $...:...... .�� lDrow existing and required addition on reverse�tidal I hereby certify that I have prepared this application and that the work will be dons In accordance with San .tedquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquirii local Health District. Herne owner or Ilion- sed agents signature certifies the following: - - .- r "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” CLARENCE'S SEPTIC & SEWER SERVICE 263 So. Oro � Stockton Cant. 05205 Signed .................. .. .. ......... . --..........•-...... _.........._- �• ' { ` .. Owner P_t}_463.3209. -Contractor's LiC..#2671U r By ....-.. ... - •------------- ---- -- -------- .._...._ �tle --... ................._...... (I or than owner) . FOR DEPARTMENT USE ONLY AP.P_LIGArION ACCEPTED: SY . . DATE .. .. :....: BUILDING PERMIT ISSUED .- - - - --- . ."„"•`DATE' _,.. �.,�... ,�.. ,.� w--- .... ALODITIONAL COMNTS .....�7y71-1 . ............................... ....~ . . . --• .............- ............. . c ... .....--•-.-••••....:... ..... ..-......-..._ ........-. ..1! ....----.......-.......... ....... ........................................ ........ .. ..........-....................................-- ............................,.................................................. . Final Inspection by: ...... -.._...-.Date . = r�... ........................ EH 13 2h 1-68 SAt JOAQUIN LOCAL HEALTH DISTRICT 8/74 3M