69-605 - Laserfiche WebLink

Home Browse Search

° 'FOR OFFICE USE, APPLIcAnON FOR SANITATION PERMIT ' '-- ilt Permit No. 61 .Cao (Complete in Triplicate) -- --- --- •---------- ------------ --:-`--_-- Date Issued, 7-----5� ' This Permit Expires 1 Year From Date Issued W 4. 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: JOB ADDRESS/LOCATION _ .� CSI �1 E --�0- -------------------------------------- CENSUS TRACT ---------------------- ,1 ----------------° ' Owner's Name*-_a&'�L�_=�' (J,tllr,�rl�------ ----------------------------------------�-�--- w'Phone ------------------ --•- Address ------- ------------------- ----- •------------------------------------------------- City. Z`d�i 7 /Y----------------- -------------------------------- Contractor's Name -1/eF-S rS.----------------------------------------------- -------.License#/-77, Phone ` �------------------. Installation wil[.serve:, Residence ❑Apartment Housef] Commerciaf ❑Trailer Court',': - Motel ❑Other - ----------------------------------------- i Number_of living units:------------- Number of bedrooms ------------Garbage Grinder ---------- Lot Size ---------------- 1 Water Supply: Public System and name --------------------------------------------------------------------------------------- Private 11Character of soil to a depth of 3 feet: Sand'E] Sift F] Clay ❑ "'Peat 0 Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe f;5- Fill Material ---------__ If yes, type ------------------f �j r ` (Plot plan, showing size of-lot, location of system in relation to wells,,buildings, etc. must be placed on reverse side.) NEW INSTALLATION: -INo septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [g- SEPTIC TANK f I Size--------------------------------- _ qDepth r Capacity ----------------- Type ----------------- -- Material-----.----------------- No. Compartments ----------------- Distance •------ ------Distance to nearest: Well __SQ--------------------------Foundation -__---------_____-___ Prop. Line __s _______________ LEACHING LINE - f No, of Lines _�--- ---------- - Length of each line- ___-----____- ------ Total Length ---________-____________-- 'D' Box .___--- _--- Type Filter Materia! --------------------Depth Filter Material -------------------------------------------- Distance ------------------=-•--Distance to nearest: Well ------------------------ Foundation ------------------------ Property Line ----:-------------•-'--- SEEPAGE.PIT� [4 -R'Depth aZ- -- Diameter ___� ��__ Number -______a ________________ Rock Filled Yes ( - No i[ I ------------ ------` -------- ---------------•-----------Rock Size t� a�3 ... ' Water Table Depth - f i ♦��j�n - I O- ------ Pre , I Distance to nearest: We!! ______L_r�J/-_._____________________Foundation p. Line -..-�______.______ REPAIR/ADDITION(Prev. Sanitation Permit# - ------------------------------------------ Date _____-______ --------------) Septic Tank (Specify Requirements) -----;---- ----------•----------------I------------ ---------- ---------------- Disposal - ------------- t Disposal Field (Specify Requirements) -----'------------------------------------------------------------------------- ------------------------------------------- ! ` ! I = �- _.,.. a ____.Y------------------------------------_---------------------------------------------.--------------------------------- -------------------- (Draw existing and required addition on reverse side) I 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 Iicen- ` sed agents signature certifies the following: a "I certify that in the t erformance of the work for which this permit is issued, I.shall not employ any person its such manner a as to becom subj/e�ctt to -oWorkman's Compensation laws of California."" ' I I $ j Signed i-----_Ale ------- ------- Owner { Y. 1 -- --F---- 1 BY } -------------------------- Title F {If otherjthan,owner). F PARTMENT USE ONLY , F APPLICATION ACCEPTED BY. } - DATE __.ry 4r., ------------- -- ------- �` - BUILDING PERMIT ISSUED----------- - -=---- - -- - ---- ---------------------•------------------------ ------------ DATE ----------- -------�-- -------- ADDITIONAL COMMENTS ._5-,J _-C-o.-_- a �p_ftx__haa__x s.t_ i c .ed._irhi s_mQba l�._bo.tme--p_a k__-t-o__five__0) rented--spaces_ -k- and space ____.be--0ccupied__by__the--_owner.--_In--addition.,---three- X-1)---small------_----- dwelling--units-_are--allowed--to remain ---_ ----'Fhias- Sanitation Permit accepted for Installation_- of_ Sewage--Dispoal-_System-Serving__ONLX- six_-mobil-homes-paces plus- three--dwelling--unz-is---- ------- - ----------- Inspection by. _-`""_ """ " Date ...........----------------- ,.:. SAN JOAQUIN LOCAL HEALTH DISTRICT 'E' H. 9 1-'68 Rev. 5M