70-355 - Laserfiche WebLink

Home Browse Search

FOR OFFICEpUSE: APPLICATION FOR SANITATION PERMIT 6 , -----------------------------------•----------------- Permit No: (Complete in Triplicate) r Y�- This Permit Expires 1 Year From Date Issued Date Issued ------------------------- 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: ' f JOB ADDRESS/LOCATION . 1677 i/ -------C&M_PBE�t-l-- ---------------------------CENSUS TRACT -------- Owner's Name f---------FR./-�.f4 y,_----- -l-a-�--E ------------------------------------------------------------Phone --------------------- Address -- --- 1670 --------S-----.._c4-M-P>o_JEL_j--- ------•--. City SC0_4C" N----------------------------------•----•--- ----------------- --- ---- Contractor's Name -.- -- QD=S- SFS F .F?Aft-C- ---------.License # ------------------------ Phone ------------------•---- ...... i Instaflation will serve: Residence Apartment House-E] Commercial —Trailer Court !❑ Motel ❑ Other ------------------------------------- -•---- Number of living units------------- Number of bedrooms 3-------Garbage Grinder 'V�9---- Lot Size .AOZ �19.&F,-------------- i Water Supply: Public System and name ------------------------------ --------------------Private Character of soil to a depth of 3 feet: Sand'EL Si ❑ 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 it permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT f ] SEPTIC TANK[ ] Size-------------------------- -------------- Liquid Depth .____.-_-----------, V ------------------ Material _* _ __________ N Compartments --_--.•_-_--_- CapacitY ---------- -=------- Type - p ------- Nk - Distance to .nearest: Well - ----------------a.-------r_____--Foundation --------- ------------ Prop. Line .------------:----.-•- LEACHING LINT: [ ] No. of Lines ---------------- Length of��each line---------------------------- Total Length __________----_-----____-• D' Box ------------ Type Filter aterial --------------------Depth Filter Mat ria) -------------------------------------._-.._. . Distance to nearest: Well f -------------- ---; Foundation -------------------- --- Property Line _---_-_.-------___......= aJ SEEPAGE PIT [ ] Depth_ ------- ------------ Diame er ---------------' Number ----------------------- ---- Rock Filled Yes Ej No ❑ Water Table Depth ------------ ------------------------ -- -----Rock Size ---------- --------------------- -Distance to nearest: Well -- ----------=- ..____, Foundation ----- __________ Prop. Line --------------- REPAIR/ADDITION(Prev. Sanitation Permit# --=--=- '- 'r------------------------- Date --------------=---------------- Septic -----------Se tic Tank (Speci-fy Requirements.) "`-------------------------------------- ---- Disposal Field (Specify Requirements) ------b( T- 3� --: - ---� (- - -_--_-- �� _ -_-P-It---- f i --------- ------ €- - -=-- x--- = = __ .; -. - --------------------=------ ----- ------------------- -------------------------------------------------------------- ------------- (Draw-existing and required_addition-on-reverse"side) 1 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 certifie the following: r ! "I certify thceLio-itlu rfor ance nf the work for which this permit is issued, I shall not employ any person in such manner as to becorn subject to W rkma nip ation laws'of,California." F Signe( --'--------------------- Owner , BY --------------------------------------------------------------------------------- tr = - Title ----------- ------------------------------- --------------- --- (If other than owner) _ - - FOR DEPARTMENT. USE ONLY APPLICATION,ACCEPTED BY --------- l a � --------------------------------- ----------------------- -----. DATE ----- •fir- ��= _ ---- ._ . _ ---------------------. _ - - BUILDING-MPERIVIIT��ISSUED�__.'.,_-____--^-------------•--------------•----- -- - - •-------------------:------------DATE`•-'--r------------------------------------ ADDITIONAL �----'-----'_------ - -- ------ ADDITIONAL COMMENTS `_r t -- -{=- --- . ' - ��_ ,� ---------------------------------------------- -r__1T _ ;t4.�iFr t r i � �` r_ Fl l s� :.i�17 �7 i v' - ---------------"7[ -- - ----- < _ <- ------------------------------------------------------ /7-- - ------ --------------- �. Final Inspection by: ' - ,, Date Z- .. SAN JAQUIN '1=OCA HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M