70-384 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: r �LJ `� APPLICATION FOR SANITATION FERMI. -�} ��-�--•' Permit No. k ----- -- - fi f (Complete in Triplicate) ' ------------------------------------------- - i ----------------- This Permit Expires 1 Year From Date Issued Date Issued i 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: �L [1 V-t------CENSUS TRACT -------- ----_-S-----•----------- JOB ADDRESS/LOCATION -------- AL-K- - --- -- Owner's Name _ � `"Cs- !�- .0 ---------- = phone -- --- ------------ Address ------- ----- City ------------------------ ----------------------------------------- ----------- s---------------- Contractor's Name _�`5 � G 't ----------------------------------License # 2A5.12-3Phone 77 iKgWlationW4 WS , Residence ❑Apartment House'❑ Commercial :❑Trailer Court ',❑ Motel F-1Other -------------------------------------------- ' Number of living units:....i------ Number of bedrooms ------...Garbage Grinder ------------ Lot Size .1_(a_0X---- -------- Water Supply: Public System and name ----------------------•----------•------------------------------------------------------------ ------Private 5 /f Character of soil to a depth of 3 feet. Sand'❑ Silt Q Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑. Adobe ❑ Fill Material ------------ if yes,type -------------------=------- I (Plot plan, showing size of lot, location of system in relation Ito 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 [.I SEPTIC TANK'[ Size----------------•--•------------------- ---- Liquid Depth ------------•--------.----- m� Capacity _� .-- - -. Type��-�----- ---�- -- Mafierial____ ______-- No. Compartments -_-__ _._.__:.-__ v 1 e i(f Distance to nearest: Well ------------------------------------Foundation -----1.0- ------ Prop. Line ----_____.__-._.______ LEACHING LINE [ ] No. of Lines ---- :3--------------- Length of each line- 71.0---------- Total 'Length -- 'D' Box -----t---— Type Filter-Material`_'_"----------,---Depth Filter Material --------------.-------------_--------.-.----- Distance to nearest: Well _�?70-r-.--- Foundation ------------------------ Property Line --_------------ SEEPAGE PIT' [ ] Depth ---_-. s---- ---- Diameter ---------------- Number _-----_____.__-.----_------ Rock Filled• Yes ❑ No .0 Water Table Depth -------------------__-- ---- --- -Rock Size -------------------------------- Distance to ndb-rest: Well ---------------- ----- -------- --------Foundation -------------------- Prop. Line ---------------------- REPAIR/ADDITION(Prev. Sanitation Permit#--------------------------- --------- Date ----- • -------------------------- Septic -----------------------Septic Tank (Specify Requirements) ---------------F--.-------------- --- -- --------------- --- -------------------------------------------------•.----------------------------- DisposalField (Specify Requirements) -------------- ----- -- ----------------- -------- --------------------------------------------------------------------------------- y �= ---- ----------- -------- --------------------------------------------------------------------------- -------------------------------------------- r{ i (Draw ex'is and equ' ed addit' n4hrewill side)/ I hereby certify that I have prepared this applicatI a that th rk will be do in accordance with San Joaquin County Ordinances, State Laws, and Rules rind Regu_ ons of the S Joaqin Loca Health District. Home owner or licen- sed agents signature.certifies the following: I "I certify that in the pethework for which this permit is issued, I shall not employ any person in such manner as to becomesubjt t:Wf Compensation laws of California." --------------- - Owner By --------- ------ ---------------------------------------------- --------------------------------------- Title --- ---------------------------- --- --------- ------------------------ (If other than owner) r� FOR DEP TMENT USE ONLY APPLICATION ACCEPTED BY -.-_-- 2 - ----------------- DATE ------ -- .7.-- ---------- BUILDING PERMIT ISSUED -------- `--------------- ---------------------------------- ADDITIONALCOMMENTS ------------------------------------------------• ------------------------ ---------------------------------------------------------------------------------- f - ---------- 4 ------------------------------------------------------------------------------------------------------------------------------------------------------ ---------------- --------------------- ------------ FinalInspection by: ----------------------------------------------------------------------------- -------.Date -------------------------------------------- SAN JOAQUIN 'LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. SM