74-528 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT r^...:........................................_.... ` P p 77.._5.1 i. �. (Complete in Tri licate} Permit No. .: _....:...:.................:............................ This Permit Expires 1 Year From Date Issued Date Issued _.e7- •-7 fl Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: 11 106 ADDRESS/LOCATION --- �aN.. .__...� 'pQ6� c �>•..._...: /ES�' _.1Qj./ ..CENSUS TRACT .......................... Owner's Name � f �U� -----------------•---.. ......... ----..Phone .5.Xf'..-,;2�....,�.... �b �Jll� City --.- 1��0 ..........:........ Address .. ..-----../Y......... Contractor's Nine - 14... .// - w ... -- - �.` " 'Pho'_'T% .............................. Installation will serve: Residence[Apartment Houlef❑ Commercial []Trailer Court 0 i! Motel ❑ Other ....-- --•- -------------------- .... - Number of li ing units:_.f._..... I-JuT..berr of bedrooms / --- ._Garbage Grinder Lot Size ...��d. .. '.................. Water Supply: Public System and-n&ome ........................- .-;- ----••-- ...... ..............._..-----------Private Character of soil to a depth of 3 feet. ' Sand Silt❑ Clay ❑ Peat❑ Sandy Loam §6 Clay I oom ❑ Hardpan ❑ Adobe ❑ Fill Material .,...._._... If yes, type ........... .... (Plot plan, showing size of lot, location of system_ in relation to wells, .buildings; etc. must be place on reverse side.) \Nt ,* NEW INSTALL, T10N: (No septic tank or seepage pp+t.peFMltfed if public sewer is available within 200 feet,) i i"C ( , r PACKAGE 7Ri*ATMENT [ ) SEPTIC A"i�lK`; ]►� Size.�X._q_Y_.'5......:............... Liquid De th .... .............. Capacity j�o-r�...._.._ Type 120PW�4.7Material.............. ........ No. Compartmrents .... ::..:.. ti ..... i Distance -to nearest: Well .` ._�_•,.___,.-,:..,_.__...Foundation /Ca............. Prop) Line .07 LEACHINGa�?...to.... 6 L! I: [ ] Line No. of s .. Length of each line. _'...... .........._ Total LengtA $moi �.._........ DCI ,.. 'D' Box Type Filter Material _1./ x._'_,Depth Filter Material . . 1, ............ ...._--,.__-_ � Distance to nearest: Well ........ _ _.-_.-_--.-_ Foundation Property Line ________________________ SEEPAGE PIT Depth %' ---- _ [ ] _ p _ ... .---- .-- - -- _ �` . . .. R k Filled Yes ❑ Na ❑ Diameter�.�._ .�_ Number Water Table Depth ..................... ......._.... .`,.......-Rock Size,,.... ..................... n REPAIR/ADDITION istance to nearest: Well ........_._.gy m._ _. __w _Foundation,..,_.,,,,........'.... Prop. Line ...................... / ION(Prev.{Prey. Sanitation Permit t# ----•--- ............. DateI....---...-..-.--_---__- ) . :j } 7 Septic TankIld (Specify Requirements) .... ........ . "-- -- -`` ........ . b --------- ......-----.... •-•-------- - 23 Disposal Fi (Specify Requirements) ......................... ............... ............ ..... ... .. ................ .. ..... .r.........._...._...-,..-: . ------ ...... -- ..... .. _ xt._--... -------- (Dra'w existing and required addtion on everse I hereby cer14 that I have prepared this application and that the work will be,done iWaccordance with San Joaquin 'county Ordinances, State Laws, and Rules and Regul&tions of the Ianoo gaiin Local Health District. Homo owner or licen- sed agents signature certifies the Following: } ;tom •' � I certify that n the performance of the work for which this �etm t is s sued, I sNall not employany person in such manner i -as to become subject t (Wo an s ompensation=iav�s of California I Signed Owner --,� . By ................... .......I.......... _ ... ;Title _.. � . ! (lf other than owner) � � 1 EOR DEPARTMENT USE NLY, _.. _ ' APPLICATION ACCEPTED BY ..... ........ .. .. . ---•---—. ...._ .., DATE __.G_. �.._._ ................ BUILDING PERMIT ISSUED .. ......... .... .......... ..... ..............DATE _ . ..__..._ ADDITIONAL COMMENTS ..... ( ---------------------------------------------------------------- ---------------•-.----- --- ----•-- - ... -k--, ..... - _._._.._...... ._ ... _... - � 3 i Final Inspection by: .... .. Dote .G:...y5'-2`. ._ ..-- ----------------------- . y............... SAN-„JOAt UIN LOCAL .HE LTH RESTRICT E _ . • a E E. H. 13 24 1-'6S RP.._ 5M � .,,�_$. ' 71723 .9