70-797 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: + ,. ] ------------------------------------ APPLICATION(Complete FOR SAMTAa eON P�pER{,MIT tt Permit No7?4__-_7_j'7 -+ Date Issued/P'd/77' . This Permit Expires 1 Year From` Arte Issued. t 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 _ -L- --- OSP / - � �r �ovT�clk),--CENSUS TRACT ---:_S__ --- Ownier's Name ------C 10 __ 10 -Phone$� -� F Address -------------------------- City�_�_7W&Zw�'C' ----''= '-------------------------------•---•-- Contractor's Name ---7 �X�AR __.____-__ ----------------------------------------------License : . _... Phone&_?,�?=340 �� Installation will serve: Residence [j!!rApartment House'E] Commercial ;❑Trailer Court ;❑ -- _. ! ❑Oth Motel o e er -------------------------------------------- /�� X Nag ber of livinunifi`sNumber of bedrooms ------Garbage Grinder '^--__ Lot Size __ ________________________________-._. rWater Supply: Public System and name ------------------ ---------------------------------------------------------------------------- ------Private L � Cl4aracter of soil to a depth of 3 feet: Sand:�It.] Clay ❑ Peat❑ Sandy Loam -❑ Clay Loam �-Hardpan ❑ .g,-AdobeLL❑-_Fil!_Material_,Ni).____If_yes,type _---__________________________ (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 sew r is available within 200 feet,) "0' G PACKAGE TREATMENT I ] SEPTIC TANK:[l� Size__c _x _X �_____-.-_ Liquid Depth __________ Ca acit 4 t46_�------ T -- � __ N;. Compartments ------------- It - p Y� yp ��_ Mafieri ------------------•--- Distanfly ce to nearest: Well __ ___________ ___________Foundation 14)__.__________ Prop. Line ___:________ LEACHING LINE [�]�No. of Liness,�_________________ Length of each line__�TQ_'_______.______ Total Length _ ._�____________. D' Box x's -__ Type Filter Material4<4'�-------Depth Filter Material /F ________________________________ Distance!to nearest: Well ,40--�________.__ Foundation J�_�.____.__-___ Property Line �-'------------- F SEEPAGE PIT [ ] Depth _ __ _____________ Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No C3 Water Table Depth ------------------------------------------------Rock Size -------------------------------- Distance to�(nearest: Well ------------------- ----------------,---Foundation -------------------- Prop. .Line --------_- --`-. ---- I REPAIR/ADDITION(Prev, SanitationlPermit S# -------- --------------- Date - ______________________________) Septic Tank (Specify Requirements} -----------------------j------------------------------ � ------- ------- ` ' 1 Ds posal Field (Specify Requirements) ------------- }---------- - - - -.k -------------------------------------------- ---------- --- ---- l s - -- a � -- ----------------- ^; l and;.req.ui�ed-d`ddition on reverse side) I hereby certify1that I have prepc�ed this-application and that the work will be done in accordance with San Joaquin County-Ordir►arices, State Laws, and Rules and Regulations�of the San Joaquin Local Health Districetome owner or licen- sed agents signature certifies the f{{.allowing: 1 f "I cdrtify that in the performancelof the work for which this Wamiris tsued;'t-, I -not employ.'any-person-in~such~manner as to become sub'ect to Workman's'Com ensation,laws of California." I Signe s- .---- R :a ------------------- -- --- Owner i 1 --------------- .� 1 r , 'h.,� 1 By 4 Title - ---7Z,_i9. . F I other than ownelp 1 I z t i FOR_dEPAitTMENT USE ONLY 9 BUILDING P R1�4iT ISSUED ------------ - ---------------- ----------.._.--- -.----------- w. --- --- DATE j APPLICATION XCCEPTED BY ..__ ___t_ _. C� __ D _l-/_-=-T7__.`_.__ ADDITIONAL!COMMENT .-�` f{ -------------- � _-----. -. a ,,-„� t -------' ------------------i --- --- -- - - - ----- --------------------- ------------- ----------- -------------- 1•-- -- �. ---- ----------- ---------- ----- ---------- ----------------- - --------- -'-- ---- FinaP!ns •--..,�__,. .. � _ �w.4� - ---_� -a, - - --------• --- ---------- ------------------Date � ---� . SAN JOAQUIN-LOCAL HEALTH DISTRICT = Y.;_N E. H. 9 1-'b8 Rev. 5M