70-364 - Laserfiche WebLink

Home Browse Search

1 FOR OFFICE USES APPLICATION.�FOR SANITATION PERMIT ' - Permit No 'd =: „'�{Camplete in Triplicate) ---------------------------------- Date Issued _5 .7 ------------------------------------- This Permit Expires l Year From 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: [��\ = ----CENSUS TRACT _ ^-1-------------- JOB ADDRESS/LOCATION -- �.---� � '� � ""-J--------- - {� p v Phone__tel�g VDj Owner's Name __`-1�1�' j ------------------- Address __-5k2-z--- "��C'_ L ------------------- City v C --- ------.License # ---------- ------------- Phone --------------------- ----- Contractor's Name ---Se'1-j---- ------------ ---------- ------------- ---------- --- 1 Installation will serve: Residence ❑ Apartment House�Commercial ❑Trailer Court Motel ❑Other ....... �i-gX--------------------• a0® Number of living units:__---- Number of bedrooms ------4- V__Garbage Grinder --1S.-- Lot Size --- -- --- ------ ------ Water Supply: Public System and name ------------------ -------- Private, Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loom ❑ Clay Loam Hardpan ❑ Adobe'�Oill Material If yes,type ---------------------------- (Plot ------------------------ -(Plot plan, showing size of lot, location of system in relation`foZells, buildings, etc. must be placed on reverse side.) 1 NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) j PACKAGE TREATMENT [ ] SEPTIC TANK'[�A- Size_- X - -X--6------------------ Liquid Depth ---"t- d------ '� _____ Material-Ca_Nec xe.,------ No, Compartments __�____-____- Capacity�a� ---` Type ' ---------Foundation __ �------------- Prop. Line _ -----•----- Distance to nearest: W RO cc r f LEACHING LINE [ ] No. of Lines ----�-------------- Length of each line------LSD___------.------ Total Length ,---1_�- ------------• `D' Box _.�____ Type Filter Mater�al�i+k _Depth Filter Material ______ __ ----------------- Distance to nearest: Well _�-Q--�- ------- Foundation --A5** _ ------------ Property Line -- ----------•----- __ Ile Rock Filled Yes N3" No id I' SEEPAGE PIT [ ] Depth _--��---- ----- ,.Diameter X(�---_ Number ----------�---fir f SU(`,?S Water Table Depth -----Q©------------------------------------Rock Size '----------------- 3 1/ --- Pro Line - [ --•------- Distance to nearest: Well ��-----------------------Foundation __�_��-_---.- p• • Date --------•------------•------------) REPAIR/ADDITION(Prev. Sanitation Permit# ------------------------- Septic Tank (Specify Requirements) --------------------•----------------------------------- ------------------' Disposal Field (Specify Requirements) ___________________________________ ------------------------------------------------------------------------------------------------ ----------------------------------------------------------------------- ------------------------------------------ ----------- -------------------------------------------- (Draw existing and required addition on reverse side) hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin w County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: - r "I certify that in the p rfar of the work for which this permit is issued, I shall not employ any person in such manner as to beco a object W k an's Compensation laws of California." Signed-*------. - ----------------------------------- Owner i - - ---- --------- -------- By ------------ - - ------------- - - - - ------------ ----- Title ------------------------- - ---------- --------- ---------------- �. (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --------------------- DATE -----------fir ------I------------------- BUILDING PERMIT ISSUED --- --- - -------- DAT ADDITIONAL COMMENTS - ----------- - - -- -------------------------=--------------------------- ------------------------------ -------------------------------------------------------------------------------------------------------------- Date -------------------- Final Inspection by. { SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M