70-854 - Laserfiche WebLink

Home Browse Search

t GFOR OFFICE USE: q �. \ of <. APP14CATION `FOR SANITATION PERMIT c -- ---- Permit No:.D--Jd-5.. i=3o f {Complete in Triplicate} --- - ---- I "------ Date Issued il=-l-7--�76 This Permit Expires 1 Year From Date issued - - .- A i anon is hereb made ' ~ � . ------------------------- pp ' y de to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in com lignce wit Co ty Ordinanc o. 549 and existing Rules and Regulations: ! F ACT JOB ADDRESSAO ION . --- -- .. -- ---- � ""�--._CENSUS TR--------------- ` Owner's Name -- '---------------- ---Phone ------------------ F__(._ - __-_--_ _ _ _- ___ - ( -t-r �� ' ` itY - Address ;it--------- - Contractor's Name : - - ---------------------4 i ` r --------------------- ` f _.License Phone-.. I Installation will serve::, Residence ❑ Apartme ous Commercial E]rail C�ou t J❑ f r�nMotel . ther Number of living units". j ...--.,c Number of red1 rbage Gri 1,------------ e ❑ PrivateWater Supply: Public System and'nam _ Character of soil to a depth of 3 feet: Sand'❑ Silt ❑ Clay Peat ❑ Sandy Loam [`] Clay Loam [I aterial Hardpan E] Adobe' Fill M/ r... If yes, type ___._______ ,�?___________ -- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be.>place&'on reverse side.) NEW INSTALLATION: {No septic flank or seepage pit permitted if pub'I'C sewer is available within X70 feet,j; .�. PACKAGE TREATMENT [ ] SEPTIC TANK [� Size__ y -_9------------------ ----- Liquid Depth ____•.�___.__-._______, �` ��`, apacity 0(------- Type Pt%t__&745f' Material __ �Co'p 6t ents `--------------- -- No. a m Distanceto nearest. Well---------- - .---F-oundation --- - ___ Prop. Line ______________________ LEACHING LINE N`o. of Lines ------------------ Leng#h offF eaeli"Ifne`,___ _ _ .. _ _ �? Total Length _: -. -- p r N V J D' Box __ Type Filter Mat "r _- _De 4ilTerlerial __(�:_�------------------ Distance nearest: Well __.__._:_ _- Foundation,•_-_0.1-r-------- Property Line ............. SEEPAGE PIT [ Depth '___ ---- Diameter; - .Number _f__--_----- ___--_--- Rock Filled -Yes j� No 1. _ c / , Water Table Depth----------Ca t--------------- --- --Rock Size ----- °%X__7_ ----1---- Distance to nearest: Well _____.___.__-`______________w__Founda'tion _.�__---_____ Prop. Line -----_________.. REPAIR/ADDI-fICiN (Prev. Sanitation Permit #--------------- --------------------------- Date ____-_-__ :----------- 3 Septic Tank-•(Specify Requirements)------------ --------=-----=- ----------------------=--------------------------------------------------- I --------- ---- -------- Disposal 'Field (Specify Requirements)-------------- ------------------------------------------- ------ 9 ' --------------------------- ----------------------Y-"-------------iN .6 ,� -1--___--.__.-.,•?��L__ f _�T-_' _^"`" =------------------------------------------------------------------------- -.------- ------------------------ ------- ----- (Draw existing and required addition on reverse side) I hereby certify that I hive 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 licen- sed agents signature certifies the following:¢ "I certify that'iri the performance of the.work for which this permit is issued, I shall not employ any person in such manner as to become'•s`ubject to `Workman's Compensation laws of California." w. Signed = r JR - , Ow6er ----------------------- Title.--- ---0 -------- ---------------------- --- BY----------------- (if oth than owner)- i' 1 / FOR .DEPARTMENT USE ONLY 67 APPLICATION ACCEPTED BY----°�L�/ /- ------------------------------------------- DATE ----fir BUILDING PERMIT ISSUED _ "----------------------DATE----------------------------------------- -------------------------- ------------------------------------ i ADDITIONAL COMMENTS ------------------------ j I , ----- ------------------ ----------------------- ._----------------------------------------------------- -------------------------------------- ---- s -- - - - f/ ----------------- Final Inspection by:--------`� - -- -- --------------------------- Date - - f ---------- SOAdUIN LOCAL HEALTH DISTRICT k E. H. 9 1-'68 Rev. 5M