69-414 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ------------------------------------ Permit No. [Complete in Triplicate} This Permit Expires 1 Year From Date Issued Date Issued _5__a23__�� --------------------------------------- Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application i ade ' compliance with County Ordinance No. 549 and existing Rules and Re7;9.11 . 1f7S0 A) • Kr�w'�� i � J �/� �� JO9 ADDRESS/LOCATIOT�1 -- f� / v-l=- • .S (� GENS) TRACT - /��- ,/1` 4'x_1_ / -- -------------Phone ------------------------------------ Owner's Name __�� - - --- - �---------------------------�- - -------------•- -- --- --- f` Gr----------------------------------- City _,.�'-��l;------------------------------------....._ Address ----------19-R-9-0 _ Contractor's Name ------,/end-� = 4- ---------------------- ----------License #/� OF - Phone��.4r_Ztglgg�' Installation will serve: Residence W�ofipartment House❑ Commercial ❑Trailer Court 0 Motel ❑Other -------------------------------------------- / Number of living units:_____ Number of bedrooms------Garbage Grinder _/V17 Lot Size __ !'-----------------•-•• Water Supply: Public System and name -----------------------------------------------------------------------------------------------------••-------Private R: Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe Fill Material --------- -- 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 sewer is available within 200 feet,) J PACKAGE TREATMENT [ ] SEPTIC TANK:y Size_4(X_V.X_------------- Liquid Depth !-__--..-__,___. Capacity _/,Z _-- TypefV/J. Material-6,pCa -- No. Compartments ---? ............. Distance to nearest: Well ----4!5,40-- f------------------Foundation --------- Prop. Line _ •-- --_-----.... LEACHING LINE [ ] No. of Lines _____-�-------------- Length of each line-.-- ------------- Total Length __�.�1�_--:-------.. e f 'D' Box -,4 Type Filter Material �Z11 _ epth Filter Material __ _________________________________ i 0 Distance to nearest: Well __. l�____________ Foundation _�0--___________ Property Line ___ SEEPAGE PIT [ ] Depth ___ __- -- Diameter Rw_ ____ Number _________________ Rack Filled Yes No I] Water Table Depth -------!11----f-----•----------•------•-•--Rock Size ----- - --------------- Distance to nearest: Well � Q_____________________ Foundation __ --•---- Prop. Line ....__-...-_____--__-_ REPAIR/ADDITION(Prev. Sanitation Permit T# -------------------------------------------- Date ----------------------------------) Septic Tank (Specify Requirements) ----------------- -------------------- ------------------------------------------------------ Disposal Field (Specify Requirements) --------------- -----------------------------------------------------------------------------•----------- --------------------------------------------------------- Draw existing and required ad'--------------------------------------------------------------------------------------------- - - ---- -- ---- - - ---- clition on reverse side) 1 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 District. 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, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed ---- ---------------- --------------- ----------------------- ---------------- Owner BY --- -- - -- Title (If other than ner) -FOR .DEPARTMENT USE ONLY q APPLICATION ACCEPTED BY --------------------------- -•--- . DATE --�' ------�6,-/ ------------ - -------------------------------------------- - - BUILDINGPERMIT ISSUED ------------------------------------------------------------ ---------------------------------------------DATE ------------------------------------------- ADDITIONALCOMMENTS -------------------------------- ----------------------------- -------------------------------------------------------------------------------,•----------- -------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------*___------ ------------------------------------------------------------------------------------------------------------------------------------------- ------- --------------------------------------ionb ------------------------ ----------------------------------------------= Final Inspection by: -_ --------------------------------------- Date - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M