75-230 - Laserfiche WebLink

Home Browse Search

tu Pf/ V-3 &►v FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. -7S--230 _ --- --------------------------- -------------- ----- (Complete in Triplicate) ---------------------------------------- ff!! ----------------- Date Issued -1--��------ -------- This Permit Expires 1 Year From Date Issued 11.5v 1 Application is hereby made to the San Joaquin Lo al He Ith istrict for a permit to ,construct and install the work herein described. This application iS/r��e� mp it�Y Ordinance No. 549 drYd existing Rules and Regulations: �• CENSUS TRACT JOB ADDRESS/LOCATION _--�------------------f __ jam Owner's Name �' - -- - -- Cf .. ----Phone ----- f • ,,�....� ,.. .®Cit -- Z------- ----------------- - --------------------- Address --------------N--- 1's— I- VF_ r- � - Y Cont�acto �------------- t Lice Phone rite # es'ide�nce artment Douse,❑ Commercial ❑Trailer Court Installation will serve: R lP Motel ❑Other _* I NSm ber of living units:----�--- Number o bedrooms __- arba�ge Grinder .------- Lot Size m. 9 IQ � �!_Private,�l` IQ" SuppEy: Public Syste6ind name - -------- ---------- ------- -------------- ; Chq�ra"cter of soil to a cle h of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam •❑ Clay Loam, i t p� Lifti Hardpan E^1Adobeo, ,M terial If.lyes, type ------ --------------------- ° (Plot plan, s"hodng size of lot, [o`'ca ,ion of sylflrn in vela ion to wells, buildings, etc. m�st be placed on reverse side.) NEW'INSTALLATIONc,. {No septic lank or. eepalge-pit-permitted=if-•public sewer is availabie within 20111f . .. .,, �� �. F PACKAG $k—EATAl1ENT [%] SEPTIC TANK:"'\ �€ Size----------------------------------- ------ - Liquid Depth-�r�-_---_______---.-•--- ' 4 p y � _ -- T e ii4 � 42 Material-_CeA(CkkN Compartments ----------- Capacity ___- -.-------. Ca acct Yp �-;.: • I'L:t� c 1 Foundation _ �_ - --_ Prop. Line ___�rl 6 -- --- Distance to nearest: Well ® ` LEACHING LINE No. of Lines - �.j Length o ac line - �'�------------Total Length s�- F--d -- -0 'D' Box ------1_---- Type Filter Material - ----Depth Filter Material -___ - f - ---I-- Pro er LineDistance to nearest: Well ---1.0 _-t_ Fo ndation ____17. - Property SEEPAGE PIT Depth _0.1 / .-- Di a tuber - ------------------ Yes No ❑ Water Table /Depth ---------- ---=--------Rock Size --- !lam -� �� A ----------------Foundation Prop. Line Distance to nearest: Well ---_-- - _(! - REPAIR/ADDITION(Prev. Sanitation Permit# ------------------- Date ----------- - k_1-----------) 1 Septic Tank (Specify Requirements) -------- --------- � Disposal Field (Specify Requirements) ------------- ------------------- ----------------------------------------------------------------------------------'---`--- "-------------------------------------`------------------------""""-----------------`------------'`") -- - (Draw existing and required addition on reverse side' I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin 6 County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Focal Health District. Dome owner or icen- i. sed agents signature certifies the following: t r "I certify that in the performance of the work for which this permit is issued, I shall 60Amploy any person in such manner 1 as to become ieFt to Workman's Compensa ' aws of California." t Signed - ?v" G�I ----------------------- Owner By ----------------------------- Title --------------- -,--- ------------------------------------------------- (If other t an owner) I M FOR DEPARTMENT USE ONLY I DATE -- ----- - APPLICATIONACCEPTED BY ----------- ----------------------- - ------------------------------------- BUILDING PERMIT ISSUED -- —_ _ _ g,ATTIE -- ADDITIONAL COMMENTS -- C 6"--_—`- -------------'----- R- ,-- '-------- ------------ -- ------- --- --- ----- ----- ----- '� `�' , .- �.a -- --- _ -- _ --- -- . ``� -- -------- ---- ----- ------ - -- -- --- ----- --- ---- Finai Inspection by: .-- _ - -d�R ! f Date - �. � - SAN JOAQUIN LOCAL HEALTH DISTRICT �€ ' f E. H. 9 1-'68 Rev. 5M