76-930 - Laserfiche WebLink

Home Browse Search

tVR OFFICE USE: ------ I APPLICAT16N FOR SANITATION PERMIT (Complete in Triplicate) 'b Permit No. •-• This Penn>iit Expires ? Year Front D " ............................................. This p Date Issued Date Issued .I��:>�. Application is hereby made to the San Joaquin focal Health District for a permit to construct and Install the work herein described, This application is mode in compliance with County Ordinance No. 549 and existing Rules and Regulations: i JOB ADDRESS/LOCATION ..-..4267--W. Turner-. „ •..---.. •• .........CENSUS TRACT .......�-. .... •hod i............... Owner's Name .._Lo u�.s.;;?el1"e s ..... .. ........ ••--•••-• .....---Phone .3,68.444 Same j .... Address . . --...: ..._ ................. .. ........... ...... .... -- __....---.._._.... ..............I City Contractor's Name -G--.&... C.._Tank---S-9_r-b:........ ....... License # 30-, 7..-21... Phone 3 . .E . . 3.3 Installation will serve: 3 Residence.Q Apartment House fl Commercial ❑Trailer Court >� Motel 0 orhei_-_-:.-_._ Number of living units Number of bedrooms ......Garbage Grinder ...TLQ.... Lot Size ........................... Water Supply: Public System and name .........�........ ................ ............................. Private -- rr Character of soil to a depth of 3 feet: Sand b Silt• Clay ❑ Peat❑ Sandy Loam• , Clay Loam ❑ V Adola Hardpan [� e❑ Fill Mctteriai ` . � ..-......... If ye:,type............... ............ , (Plot plan, showing size of lot, location of system�In relation to wells, buildings, etc. must be placed an reverse side.) NEW INSTALLATION: , (No septic tank or seepage,pit permitted If public sewer is available_ within 200 feet,j - . PACKAGE TREATMENT' ( ] SEPTIC TAMC -' ] Size... ..................................Liquid Depth ► Capacity = Type Material... ............... No. Compartments Distance to nearest: Well ............. Foundation .. i - g _ Prop. Line LEACHING LINE ----..__ ,x�. ---•.................. l No. of Lines Y £ -_---y _ _ .. . . ----- Length of each line-.--••-----.... �"�_ ..... Tota Length D' Box _.- -__.- Type Filter Material .....Depth .Filter Material ...... --Distance to nearest: Well ........................ Foundation _-...................... Property Line ... SEEPAGE PITp - Diameter De th -77t-.....-....---•------ Number .............. -----•.... Rock Filled Yea ❑ No � i `= Wates Table Depth.....:................ ..: -----•-•-•=--Rock Size ....----....._.._.. .. _.. + - V to nearest. Well REPAIR/ADDITION(Prev. Saniitattion_P.ermit# ---..__.. .. _._.................... .__ Da undation .................... Prop. Line ...................... Septic Tank S -. t t �. ..............•---•-------_ e j P ( pecify Requirements)•`=__:___. -,-_.._ •T.=..... ..................•-----•---•--•---- ---••-... ,......... •----_........--•-- Disposal Field .ISpecify Requirements) SQ.1` Y��..�n�_ n_bDU- v�a.nd,;,8p t3 ' eae t line on little iaou"se�in back ---- n _- ..._ ' --'•---------- ----------------------------- ;; 4. -------------- - .................... -•••-• --------------- ................................:.. {Draw existing and•required-odditioh-on reverie—side).' I -hereby certify that 1 have prepared this apislication`and.•that"the work will beTdone in accordance with San Joaquin County Ordinances, State Laws,fai nd Rules and Regulations of the,San Joaquin Ll HQa1th;DIstrict. Hence owner or liven- agents signature certifies the following: x Local _ "I certify that in the performance of the work for which this permit is Issued'.I'shall not'e"p oy1 any person In such manner as to become subject to Workman' Com ensation laws of California." Signed --••--- ° - .-- ---- - By •--•-.. _ Title - tamer-.-.C--.$r.. .. f other than owner) f. S 'fit �- -T ,:qk-••Se-r. —z FOR 0I PARTMENT USE ONLY APPLICATION ACCEPTED BY _- . �: - - DATE.. ...�d----'?$ -7 BURf1ING PERMIT ISSUED _.._"___-_ ---_"-._ . • --- - - ADDITIONAL COMMENTS ----------------•-' .------_ ------••---------._ ----DATE ----- - ----------------------------------- --- ---------------•---------.._-_---•---=•-----•------_---- - a Final Inspection by: .................. _ EH 13 2� 1-513 Rev. 5H ' � ------.....................-- •-...._.__.__.... ........Date -../�J 2$':�G. SAN .JOAQUIN LOCAL HEALTH DISTRICT ........ $/71; 3M