SR0081818 - Laserfiche WebLink

Home Browse Search

Ali OFFICE USEt APPLICATION FOR SANITATION PERMIT •• {compieto in Trlpllcate! Date )cooed .�........:..�� .......�.� This Parrttlt Expires! Year From Date Issued � ............. lth ict .pplkatiwa is herelsy made b the San Joaquin LocaW aith �uDytrprdinfor anco permit and ng RuleaInstall tReg bons, and described. This application is made in compliance T N •. .J•........ O.,c. /`� �r (�...Rb..............CENS/I ' TRACT l,..,........... ......-.. J09 ADDRESS/LOCA ....... ............ ...... J ?! . Owner's Name - ' ^' ""•. .............................. '-f"�`L�.....Z�d.!4 +A1S L ------.1.1e�.............................•,City .,.�!El.�� .. � Address ....._ .._...Liconse # ..... -Phone .............................. .. s Contractor's Name ..... .......... ...............__........---... ................... Installation will serves Residence[ft/Apartment House Commercial Moller Court Motel Q Other ......................... f living units:. l Number of bedrooms ° -Garbage Grinder ..._.._..... Lot Sin ..._...- ... Number o -•• ---• 1 iprivOb Q Water Supply: Public System and name ....•--•-•...................... F.......................... - ...��-- day Loam t� Character of soil to a depth of 3 feet: Sand D Silt Q CIy D---Peat❑ m Sa i Hardpan Q Adobe 0 r Fill Material...........if yes,............................ (Piot plan, showing size of lot, location of system in rotation to wells, buildings, etc. must be placed on reverse stdal NEW INSTALLATION: lNa septic tank or sea pit permitted if public sewerisavailable within 2Q0 feet,} ,r ... Liquid Depth . 4........-_.._. PACKAGE TREATMENT [ 3 SEPTIC T [ Size_..o?_.. . _....................... OT e r ,,�Z'Material.. N. 'No. Comportments ---s .....-.._1 Copaci yp ../D.:F:......... Pro Lina .��.. ___..... .Foundation p ..j� • Distance to nearest Well -=f....................... _.. A00 ...._....... Total Length -10Q-.A._........ LEACHING LINE No. of Lines - ---- Length af�each line—A00.1 c, IV 'D' Box y),-.,S-_ Type Filter Material Depth Filter Motorial ........t..........� . ...... Distance to nearesh We .f...... Foundation ....1Q_- ._........ Nape" Line .. Dept Diameter Number ............................ Rock Filled Yes © No SEEPAGE PIT ( ! ................ - ----^^--- Rock Size . WaterTable Depth ................................................ Distance to nearest: Well ........................................foundation .................... Prop. tine ........._............ _ Date ...............� REPAIR/AODETION Rev. Sanitation Permit# . r septic Tank (Specify Requirements) ...................................... .....��............ ....... .. ...........-.....-_._•,- (Specify Re uirements! .............................. Disposal Fieia q •-••.................................................••-•-•-._..................._................_.----......................_.._.. ........................ (Draw existing and required addition on reverse side) nt� � San Jo �tdn I hereby certify that I have prepared this application and thot the work will be done In aaorda County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Lowt Health District.Homs owner or Ilcertr sed agents signature certifies the following: 1 person 1n such manner "I certify that In the performance of the work for-which this permit Is Issued. 1 shat! not employ any as to become fact to Work0bn' ompe orlon laws of California-" .-- ....__._..Owner Signed ........ By _..---- ...................................... ...... Title -......_... - (if other than owned FOR DEPARTMENT USE ONLY DATE ...._ -. .-.: �.................................. _ APPLICATION ACCEPTED BY .....VA-Kr....'. ....................._. DATE ... BUtLDING PERMIT ISSUED ............ d�0..�1 e�-.�A!•1��D1. .......-.......-_...._.._-......._.__. Af?DITiONAL COMMENTS._.... ........................ ............................................. ....__._......---•----- .... ..... ____________________ _____.._-._. lrJ•. _ ftr, a..........- .............. .Date . _ --..... , rr Final Inspection by: _- 1 DISTRICT $/7� 3MEH 13 24 1-68 Rev. 5M SAN JOAOUIN LOCAL HEALTH