69-727 - Laserfiche WebLink

Home Browse Search

r FOR OFFICE USE:4 � APPLICATION FOR SANITATION PERMIT l� ,�' Permit No. ----- �" (Complete in Triplicate) T ----------------------IN Date issued - ---'------ ,}µ. ------------------ This Permit Expires l Year From Date Issued �I. +Ordinance 6' Application is hereby mode:to the San Joaquin Local Health QistOr for a p om549 and construct g Rules and tand Regulatioall the work ns.. 3 O 3 �� CENSUS TRACT described. This application �s made in compliance wit Count � ----- i and ►-. � .-- --------- ---:--- ------JOB ADQRESS/LOCATION .-_--- -- --- 23 `�3 ___--- SS - ------- Owner's Phone Owner's Name _ /V!-O_�_ ------ --� ------- ----=- ------------ City - --�------- ------ W `� -------------------------- ----------------- ---- -•-- Address /_9_ 6 _ License # :7--g371_1�----- Phone,�Z- . _6s- Contractor's NameA = I' I . lnsta�liation-vvill.serve: Residence El Apartment House Commerci . al ❑Trailer Court fi Motel ,Other. CNf}J F- 51� f ----------- - Garbage Grinder _.__--__---- Lot Size --,:- --------- Number of living units:_-__'�M Number of Be __ rooms ___------ Private ll Water Supply: Public Systeand name -------------------------m Clay Loam,10 Character of soil to a dep. of 3 feet: Sand Ef Silt❑ Clay ❑ Peat-❑ �Sdndy Loam ❑ Y f I _ �__- Ifyes,type Hardpan Adobe ❑ Fill.Materia � i buildings, etc. must be! placed on reverse side.) �I. ` (Plot plan, showing size of lot, location of system in relation to wells, NEW INSTALLATION: (No septic tank or seepage pit.permitted if public sewer is available within 200 feet,) X_ ------------ Liquid Depth _ �- .iN Size--- ----�---'-�--- PACKAGE..TREATMENT [ ] SEPTIC TANK Qja(ZK__ No. Compartments ------ ;% - --- - �I 04 &FC19�Material---_---- , CaI pac�ty - TYpe P --fi __--_______-AFoundation _f�-.- -- } Prop. Line __ - ---- Distance to nearest: Well --- = r ,�_ ------ ----- Total Length :-----•---------,, No. of Lines --__- __ -_-__------ Length of each line_.________ .Y V LEACHING LINE ] if , q ,---_1,.- -•---•-- Y�-__- Type Fitter Material _� D -Depth-`Filter Material ____--I-/--- D' Box A( 1G iFoundation --------r -------- Property Line. ----------------------•- Distance to nearest: We _ _-------------------- Diameter !_ Number ----- ------ Rock Filled Yes ❑ No i❑ ------- --------- Qe th ------- -- o SEEPAGE P17 [ 1 11,P - Water Table_Depth -------------------------------- Rock Size ij. - ----•------'Foundation -- --------- -------` Prop.. Line --------------------- Distance .-------------•- - -Distance to nearest: Well --------------------------- �I I Date -------- ---- = ) REPAIR/ADDITION(Preva`sanitation Permit# -•--------------------------- _ , Septic Tank (Specify Requirements) -------- --------------------------------`---------------^ { =� f 1 Al1TT_`C1_M_ --------------- Disposal Field (Specify Requirements) -----3STE_M_.._. - ^ t ) -------------- --------- ------------------------ �� -------- - ----- - - - - ----------- -- ---------- - ------------ -- (Draw existing and required addition on reverse s d e . { hereby certify that { hive 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 {icen- 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 fWo an's Compensation laws of California." �I w ------------------------ Owner - Signedk - ---------------- i ------------------------ Title --------- --------- ------- ; --- -- By 42 (If other than owner) II FOR DEPARTMENT USE ONLY .4 ,4 APPLICATION ACCEPTED BY ----�� --------------- _ T - DATE ._ --------.��-�_.,� ""----------•------'---- '"-DATE- _�'".—_.. - -'� :,..BUILDING`�PERMIT-ISSUED ------------------------------.. -\' --------------------------------•------------------------ ADQITIONAL COMMENTS - ----- -- --- ------------- - �Ic--_ � - - - k ` --------------------------- --------- ------ ------- --- --------- ---------- ��s P --- --- ------ - ----='M-- -- ----- ----- --- - Date ......15---- ----- ----- -- -- Final Ins - - - -- ------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5