71-286 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION Ift SANITATIONI PERMIT ------------------------- _ (Complete in Triplicate) Permit No.v _-_______------ 1Date Issued _4?1— - ---------- ---------- ----------------------- ------ This Permit Expires 1 Year From Date Issued Application is hereby made to theSonJoaquin Local Health Districty iifor' a permit to construct and nstall the work herein described. This application•is made in compliance with County Ordinance No. 549 and existing Rules and Regulations. JOB ADDRESS/LOCATION -- ------ .r4�L4=,1� -.... ?2� ------------------ -- ----------CENSUS TRACT . Owner's Name �}G2------------=---- ------------------------------------------------------------------------- -_-Phone Address ------ srrglh ___________________________________________ City --__-__�Z -K�17Z Contractor's Name .__/�l 1 S fs Wr-<�` License # � �;i � Phone Installation will serve: -Residence QApartment House-C] Commercial ❑Trailer Court ;❑ Motel ❑Other ______ /dumber of living units:._/-------'Number of bedrooj-1 Ims � � � ,Z------Garbage Grinder IX0---- Lot Size AVZ/5-0 7J- Water Supply: Public System and name ______________________ _ __ Private --------------- -------------------- Character of soil to a depth of 3 feet: Sand' Silt Clay r ❑ ❑ Y ❑ .Peat❑ Sandy Loam � CIay,Loam:❑ f Hardpan ❑ AdobeV Fill Material -----._------ If Yes, type ---------------------------- Mot -------------- ----__{Plot plan, showing size of)lot, location of system in relation-to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: - r(No septictankor seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT � SEPTIC TANK Size--------------------------- ---�- ---- �- - - Liquid Depth --- -- --------- ------•r -• `n ' Capacity = Type Material --- No. Compartments --------- ------------ 1�, a Distance-to nearest: Well ---------------------------- __•-----Foundation ---------------------- Prop. Line ---------------------- yr LEACHING LINE [ ] No: of Lines------------------------ Length of each line__..'__--__..__ 1n + �---�_" "-Total Length "` ""' 'b' Box -----I___._.__ Type Filter Material __________________Depth Filter Material -------------------- Distance _ _ __-__ _--___Distance to nearest: Well _______________________ Foundation ------------------------ Property Line. r ------------•-------- ---- SEEPAGE PIT [ j Depth -------------------- Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No 10 Water Table Depth --------------------------- ------- ------------Rock Size Distance to nearest: Well --------------------------------------- Foundation --.----------------- Prop. Line _------------r-_-__... REPAIR/ADDITION(Prev. SanitationiPermit# ---------------.---___------_-------------- Date ________.____________________,•--_) Septic Tank (Specify Requirements) ------------------------------ --------------- Disposal Field (Specify Requirements) ________ _",�}� - -.__ (�_-�� /y _S } --------------- ---------------------------------- - --------- Praw 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 Joaquin County Ordinances, State Laws, ana 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 for which this permit is issued, I shall not employ any person. in such manner as to become subject to Workman'siCompensation laws of California." 1 Signed ---.- Aotber -- _ Owner 11 BY ---------"--------- I ----------- -Title --- -------------- ---------------------------------- - than owned ) ----------------------------------------- -------- ------ ----- ---------- - OR .DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - --c,►P1 -- - BUILDING PERMIT ISSUED ---------------------------------------. DATE _ti�_�5- --------------------- _ _ _ ------------ g �, DATE - ADDITIONAL COMMENTS __. _-: e is_ .0:---?�---1` ' �/ i VV } - -- --- --- --- 4 _ ------- - - ________________________ _____________________________________________________________________ ___________________________________________________ Final Inspection by: ______________ r - ------ - -----------------------------------------Date --------------------------- 3 SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M