69-824 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE.-,- O a" APPLICATION-FOR SANITATION PERMIT r - --- ----�� - -G -------_.-__ .T ------ Permit No: .-d-� (Complete in Triplicate) =G- . ....... l / ___________________ -------------------------------------- This Permit Expires �1 Year From Date Issued Date Issued Application is hereby made to the SoneuinloCal ealPC t bistrict for a permit to construct and install the work herein described. This application is mde in c pliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS / TION !.__fi � ?c/ _CENSUS TRACT _36__________________ Owner's Namen/ !----------!'1 fG7ft --------------------- - ------- Phone --------------------------- r Address _ Contractor's Name .�°�_ !rxh-T-s �%som,slv`L_ icense* AOa ----- Phone rn Installation will serve: Residence'X]Apartment House❑ Commercial:❑Trailer Court i❑ Motel ❑ Other ------------------------ Number of living units:---/------- Number of bedrooms _-- ..Garbage Grinder ----------•- Lot Size,_ _ _____ -----------........... _. :3 Water Supply: Public System and name ------------------------------------------------- --------- ------------=------ '-•------ •- Privateer Character of soil to a depth of 3 feet: Sand'E3 Silt Cla Peat Sand .Loam Clay Loam s P f❑ ❑ Y� ❑ Y� ❑` , Y C] ' Hardpan ❑ Adobe ❑ Fill Material ------------ If yes, type ______________________ •� r ! ► r (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 pit permitted if public;sewer is available within 200 feet,) { PACKAGE TREATMENT [ ] SEPTIC TANK [ ]` Size----------------------*6------------------------ Liquid Depth ------ ------------------- Capacity --- ----------- - - Type -------------------- Material------------__7_�__ -_"_1- No.-Compartments----- -------------- Distance to nearest: Well ------------------------------------Foundation _.-------------------- Prop. Line ---------- ------ r LEACHING LINE [ ] No. of Lines ------- _______________ Length of each line-------4e;C9 --__.______ Total Length .,___-_�_4-_-----------__ D' Box --__-_._-___ Type Filter Material Xt�—___Depth Filter Material _---_� _ ____________________ Distance to nearest: Well -----404------- Foundation ----1e------------- Property Line _ --____._____--_.__ IL SEEPAGE PIT [ ] Depth - _-__-- Diameter _ ____ Number. .?_-___�-----_-----_---_ Rock Filled Yes No ❑._ ~ •80 ter- �. ., ` � Water"Table-Depth- --------------------------------------------------Rock Size ------ X�`��-------- ---- °f -R Distance to nearest:Well ----------------------------------------_Foundation -----1_0 Prop. Line -.'�....... -_-•- r - REPAIR/ADDITION(Prev. Sanitation Permit# ------- - --------------------------------- Date ----------------------------------] Septic Tank (Specify Requirements) -------- -'---------------------f- ---- ------------------------------=---------------------- -------------------------"--------------------- tj Dis osal Field (Specify Requirements) = -=--------------------------------------------------------------- --------------- -------------------------------------------- ---------- -- �J---------------------------L---------------------------------------- a ------------------------------------------------ -------------------------------------- -------------------------------------------- --------------------------------------------------------- (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 Disteict. Home owner or licen- 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 Workman's Compensation laws of California." Signe - w r ., - -------------------- ----- -- j BY. � (If of than owner) F PEPARTMENT USE ONLY APPLICATION ACCEPTED BY -- ---"- -- --- ----- --------------------------------------------------------- DATE ----- C7 ------------- BUILDING PERMIT ISSUED ----------- -- --DATE -------------•----------------------------- --- - ----- - ------ -----------------------------------------------=---------- - ADDITIONAL COMMENT --- . - - -11 ------ } � T - �� " ------------------ --------------------- ----------------------------------------------------------- ----------------------------------- ---- --- _ -- ----- -- --------------------------------------- - - -- - ------ - --------------------------------------------------------------------------------- ------------ ------------------------------=--- -- Final Inspection by: - - Date �C1 1'_Q5 0'--------- -- -- ---- JOAQUIN LOCAL HEALTH"DISTRICT- ' k E:H. 9 1-'68 Rev. 5M