72-488 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: t APPLICATION"POR�3ANITATION PERMIT�- --- -------- -----------------•--------------------- \ Permit Na. (Complete in Triplicate) ----------I--------------------------------------------- Date Issued _________________________________________________________ This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a per to construct 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 .---�0.4--NA-.---Sib1.y---- r-- ------- ------------------------------------------------CENSUS TRACT .------------------------- Owner's Name -.M-od l----`-F-:---Cons-truet-i on--------------------------------- ----------------- -------------------Phone ------------------------------------ Address ---------------- X82' E M ------------------------------------------------------ City -.-.--Stkn-.------ ------ -----------------------.---------........... Contractor's Name ---P1,aka 'ds--.S-ept1G--T-ank----------------------------.License # --2-68951------ Phone __4(.3—?048------- Installation will serve: •Residence] Apartment,House,❑ Commercial ❑Trailer Court ',[] Motel ❑Other -------------------------------------------- Number of living units:.__.]-__.___ Number of bedrooms -3- -------- Grinder __________ Lot Size ----1---AGr--e------------------------- Water Supply: Public System and name -----------------------------------------------------------------------•--•--------------------------------___Private] Character of soil to a depth of 3 feet: Sand'[] Silt❑ • Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe ® Fill Material __________ If yes, type ____________________________ (Plot plan, showing size of lot, location 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 TREATMENT [ ] SEPTIC TANK'[3] x, Size---5'x5'4"_xQ'-------------------- Liquid Depth ------48-1-1------------- Capacity _3.20-0---gaZType .... Sq-i___:_____ Material.0ana `et-e� No. Compartments __2__.------------ Distance to nearest: Well _____5Q_t________________________Foundation __a.0!._____________ Prop. Line _____3Q' LEACHING LINE [ f No, of Lines _- 2-----___---_ __'Length of each line--------B-5'------------- Total Length _____ 'D' Box __1------- Type Filter Material --------Depth Filter Material _____1_9 ------------------___....... ____ Distance to nearest: Well __59_f__.-___'=_Foundation -------30_x.......... Property Line _10-1----------•---- SEEPAGE PIT [�{ Depth ----2-5-1_________ Diameter ----3-3*::,:__ Number ___2_____________________ Rock Filled Yes E] No i❑ .Water.;�Table Depth -------------------- 0 ' ------- ----------_Rock Size ---2r'------------------------ g------'- {� Distance to nearest: Well -------10 -------- Prop. Line ........1-0.1 REPAIR/ADDITION(Prev. Sanitation Permit# -------- ----------------------------------- Date ---------------------------------- Septic Tank (Specify Requirements) 1 system stem -- -------------------- --------------------------------------- --------------------------- --.,---------------------------- Disposal Field (Specify Requirements) ------------------------------I!----------------------------------------------------------------------------------------------------- w �- -----------------------------------------------------------------------------------------------�.----------------------------------------------------------------------------------------------------------- r ------------------------------------------------------ ------ --------------------------------------------------------------------------------------------------------- (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 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 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 Ca.lifornia." Signed --------- ---------------------v -- Owner BY �t-,.C..K=---- XGt, Title ...... E (If other than owner) PARTMENT USE ONLY �. APPLICATION ACCEPTED BY - - -- - -`- -------------------------------------. DATE -----�- -F-•=7 ---------------- BUILDING PERMIT ISSUED -------- ---------- --------------------------------------- --------------DATE -------------•-------------------- ------ --- -- - ----- ADDITIONAL COMMENTS _____ __ __ ____________ ----------------------------------------- --- - - - - - - ; ] S 5'- u`? ---------------------------------------- --- --- - - -- -- ------------------------_-__------ ---------------------------------------------- _ _ _-------------------------------- _ -- - --------- - - -- -- - -- ------- --- Finaf Inspection by: - ---- -- -----�J- £ Date -- �_.`'/�� SAN JO4 UIN LOCAL HEALTH DISTRICT 7 E. H. 9 1-'68 Rev. 5M