68-699 - Laserfiche WebLink

Home Browse Search

t FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. . __________________ This Permit Expires 1 Year From Date Issued Date Issued r 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 h County Ordinance No. 549 and existing ules and Regulations:,, /�9' JOB ADDRESS/LOCATION .gyp -. rt, _te l -{/-- �rJ --- NSUS TRACT _______ --------- Owner's Name KL-�. 2 - L"VA,* ------- -----------------------------------------------------Phone Address / 7 -------- City7r"4 ------------------------- Contractor's Name --- = �� _-_ -S - -�`✓%,'----.License # --� �, � Phone Installation will serve: Residence j0partment House❑ Commercial ❑Trailer Court ;❑ Motel ❑Other r Number of living units:...._ ------ Number of bedrooms ___--Garbage Grinder ------------ Lot Size -----gip.- 5ra ----------- Water Supply: Publit-System and name ----------------------- ... - ---------------------------•-------------------------------- Private Character of soil to a depth of 3 feet: Sand'o Silt❑ Clay .❑ Peat ❑ Sandy Loam -❑ Clay Loam;❑ r t Hardpan ❑ Adob ��M rial ------------ If yes, type ------------------ ------ ' (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed 8n reverse side.) ..�t ' NEW INSTALLATION. (No septic tank or seepage pit permitted if public sewer Is�avy slable within 200 feet,) ` PACKAGE TREATMENT ) SEPTIC TANK', Size__- _ ;�_X------ -_z�_f-- Liquid Depth __»_ _ { Capacity _ _ ype ,�,�;`_--- Material(i2�_ _ 4,- t,----- No. Compartments ____��' - Distance to nearer; Well `-----------------Foundation ----- ------ Prop. Line ,ems LEACHING LINE No. of.Lines __------ Length of each line-.__s�0 g --------- -- ------------- Total Length -----------•--, ;' 'D' Box--_'j------ Type Filter Material_,, - __- - Depth Filter Materia! _.__.�_ off" -- � - - ;---��*j Distance'to nearest: Well 04 —' Fou ation u ``Property .Line: SEEPAGE PIT Depth -------------------- Diameter "-_------- Number _--------------------__-___ Rock Filled Yes ❑ No 0 Water Table Depth --------------------------------------------------Rock Size --'---------------------------- Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line --------------- REP -____-• AIR./ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ------------------.---------------) Septic Tank (Specify Requirements) _____ n F' -----•----------- i Disposal field (Specify Requirements) F -------- ---- ----------------------------- t _ a --------------------------------------------------- -------------------------j!-------- -------------------------- ----- ___ ___----------- ------------------------------------------------------------------------------- - . �_ (Draw existing and required addition on reverse side) y I'hereby certify that i have prepared thisapplicationand 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 lieen- ' -sed agents signature certifies the following- "I certify that'inthe erformance of the work for which this permit is issued, I shall.not employ any person in such manner as to become subje ` -Workman's-Compensation laws .of California." � ' � .4 -3 Signed ----------� CSr �' --- -- - ----- -- �--- ---- - - - S=F riCTANK SER'V1G--- - -- ---------- It , BY , 29TS 1= trc rfty f Title (I o erian owner I FOR .DEPAit ' ENT USE ONLY APPLICATION ACCEPTED B ---- - ------- - DATE ....;7794 0__$(------------------- BUILDING PERMIT ISSUED --DATE - ---------------------------------- - ADDITIONAL COMMENTS ---------------------------------------------------------------------------------- ------------------------------------------------------------ --- --------------------------------- 4 Final Inspection by: . Date ... �_c t- ------------ ---- SAN JOAQUIN"LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev..5M _