76-921 - Laserfiche WebLink

Home Browse Search

f -FOR OFFICE USE: . APPLICATION FOR SANITATION PERMIT ----------------------------------- •------ A (Complete In Triplicate) Permit No. •-:.: ....................................................... This Permit Expires t Year From Out*Issued Date lssued/6-:C17.`1 Application is hereby made to the San Joaquin Local Health District for a permit to constrtict 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, -,.. --3:- .-- ......./'`t.c.Y.ear,. ►..�`C. C".......................CENSUS TRACT ..._G� .....--------- Owner's Name . > :Y�'�.62.7 ............. ........•- ....................-----..........Phone ....... Address .....a.'3. .............. . •---- City ...... .............................. -:;.......... 1 Contractor's Name _.. ` ��=. ``s�._.��r.�.�!'?...,�'pec!�.��_s'. .:........:........€!.license # Phone Installation will serve: - Residence Apartment House 0 Commercial OTrailer Court I] ` Motel Q Other........ .......Y............ f Number'of living units:... . Number of bedrooms .......Garbage Grinder .*.. Lot Size .. s✓ -� � ..5............:. ' Water Supply: Public System and name .....................•---...............................-----------.......................:....................Privote I Character of soil to a depth of 3 feet: Sand Silt❑ Clay Q Peat[) Sandy Loam ❑ Clay loam 0 ' r _ F .._ Hardpan Q Adobe fl fill Material ............If yes,type............... ...........: f( p (Plot—Ocin, showing size of lot, location of system in relation to wells; builclirig`s', etc. must be placed on reverse side.)v i NEW INSTALLATION: (No septic tank or seepage ,pit permitted ifublic sewer is available within 200 feet, / f �_ PACKAGE TREATMENT„(]...�.SEPT-IC•TANK jj Size... ..�.............................. Liquid Depth .............. 1 i Ma.erial + CAxCNo. Compartments ...:L.4............a--._._hype cjtw 7F udona .•... Prop. �.....Distance+to . rectrest: Well ................ .... :.Fona#iLine .. LEACHING ZINENo. of Lines -.-.. _.-. [ � l .........:.... Length of each line---. Total length .--7-0./.............. 'D' Box ... Type F€IterMa#erial.....�Ta....::,: ..Depth Filter Material°...r c.... ............. .'. f Distance to nearest:WeU �c��:.......... Foundation s. ------------ Property.Line, .............. .. ._.fir-....� wee' ............. .,...-----------......_..._._. PA - --- --•-------•-------- ---•---._..fie ...-•---- ------------- -- D11 ..._.. .........�e+a ...................fie•.................+.._ REPAIR/ADDITION(Prev. Sanitation Permit _._._...................:.... ........... Date ........_- ..................... ) •Septic Tank (Specify Requirements).. Disposal Field (Specify Requirements) --- - -. -•••-•--------•------ °° ..------- - - •-----.-- -- --- ------. --•--...------•-- ................•-• ................. .............. IDraw existing and required addition on reverse side) i I hereby certify that I have prepared this application and that the work will be done in accordance with San Joagaln l County Ordinances, State Laws, and Rules and Regulations of the San Joaquin-Local Health,District. Home owner or licen- sed agents signature certifies the following: "I certify that in the performance of the work far"which this permit is Issued, I shaill not employ any person in such manner l as to b6come u (ect to Workman's Compensation laws of California." Signed --- - _/7.__: d Owner r. .. BY Title .. ---? : (if other than owner) tf9 R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ...- ---•-----•-••------•------ -----------•..........._........ .DATE��//� ._...;.- BUILDING PERMIT ISSUE DATE .... _ ..,. ADDITIONAL -------- .......................... -------------------------------- ..-- ........................................................... .........----............._..........................._.... ---•----• ... ..... . ...... Final Inspection by: 2' . . --•- Date .. �.. .. ._ ------------- EH .. . • � 13 21i. 1-6t3 �.._. . . • SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3M