74-133 (4) - Laserfiche WebLink

Home Browse Search

- A i FOR OFFICE USE: �I APPLICATION FOR SANITATION PERMIT �77 ------------------------ ------ ------------------------- � Permit No7 1 I (CompPete in Triplicate} _� -- ---- ---------- ------------------------ This Permit Expires 1 Year From Dale Issued Date Issued -.- E.-771 --------------------- -------- ------------------------ s p I Application i J hereby made tc the ISan Joaquin Local Health District for 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: I YEN- ACRES RIVER CLUB JOB ADDRESS/LOCATION . B C----------------------------------- CENSUS TRACT Owners Name - -Harry ----------KWELL. and Audrey--M. =LILE -------Phone 9; ?_9979--------------- ame ------------- -- - 1691 Wo II Frewert Rd Lathrop------- ------------ C --------- ------- IM _ X �/Owne r gr Contractor's yk Lice # - � Phone M Installation will serve: Residence A artrnentHouse,❑ Commercial : Trai'ler-Cou = i �9 r (1V,e41 17 N /Te"-1e.z.r) Motel ❑Other=----------------------------- ------ Number of Ii�Ming units:-____ ____ Number of bedroom�__dr___2Garbage Grinder nOC�E- Lot Size _________________---__________.____.________ I! IM ^ pOri o ert Water Supply: Public System and name -------------- we11-- -- _r---p- - -------Private A Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay E] Peat ❑ Sandy Loam X] Clay Loam C] , ��. `Hardpan ❑ Adobe ❑ Fill Material ------------ If y6-s,type ------- ------------ sf_____ (Plot plan, shIo` wing size of lot, to ation of system in relation to wells, buildings, %%etc, must be placed _on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,] PACKAGE TREATMENTkSize- � x 5 tLqIC u'^id Depth `. ' t O . --retC No. Compartments --- - -:---- Capaaty ype ------------- atena [ ] Distance tb nearest: Well _ ,�39P________________________Foundation ____________________ Pro Line-_QYC ._50___ I _. - - - , -- t "� ' r LEACHING LINE No. of [i es _f ONE________`-__ Length of`each' line---------------------------__ Total _Leng#hQ�?__________.._.__ 16 ,XI_67�f1pf� - -D' Box _=E____ _ Type Filter Material ___ -ROCk---Depth Filter ,Material -------1$11----------------- 1-1 Distance tM nearest: Well -500-=------------- Foundation ____-x-" ____ ;_ Property Line _9Ye.c---501___ --- Rock Filled Yes No SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------. Number ------- ----------------- ❑ ❑ WaterTable Depth ------------------ -----------------------------Rock Size --------------------------•----- Distance to nearest: Well --------------------------------------- Foundation -------------------- Prop. Line ____._---_______.___.. 1 /1 Se tic Tank (Specify Requirements) - = _.__,___ Date ) + -: - i REPAIRJADDITION(Prev. Sanitation Permit _ p �i Y q II --------------- ------------------------------------------- ------------- Disposal -------- - - ,.. Disposal Field (Specify Reggirements) - i R = --------------�I.�..� Vie- � _c, iiilllil ___ 7isting ---------------------- i� [Draw a and required addition on reverse side) ,,,t� 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 Health District. Home owner or licen- sed agents signature certifies the following: f "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 ct to Workma 'r Com ensation laws of California." I ` S Signed ----- r ---------------------------------------- Owner BY ------------- -----••---•--------------------------'M - ------ Title --------------- - (if other than owner)` lI IM FOk,044RTMENT U NLY # APPLICATION ACCEPTED B i - ---------------------------` DATE � -------------------- - BUILDING PERMIT ISSUED M - -----•------------•- ----- ---------------------------------------------, DATE ------------------------------------------- - ADDITIONALCOMMENTS ------------'I----------------------------------------------------------------------------------------------- ---------------=---------- ------ I it --------------------- J - ` • --------------------------------,--------------- - ---- --------------------- '---- f---------- ---- Final Ins ection by: ----r � --------------------------------------------- -------------------.Date � ______� - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1.7'68 Rev. 5M ��' „�--