69-493 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT f Permit No. _��-=✓`.�-��' ---- -- -- --------------------- --------------------- - -- ----- ----- (Complete in Triplicate) - -- --------------------- p Date Issued -------------------------------------------------- - --- - This Permit Expires 1 Year From Date Issued i Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein Regulations- described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: _ X 77 ��' ( ( f� I rt J06 ADDRESS/LO O ATION � -�`� ''"k.`r�-- l-,0--- --r = -til' - CENSUS TRACT rPhone ----------------------- ---------•-- D ndS - Owner's Name ---------------------------------- it n l~ Address = `�- --- ------ ----- -------- ---- ----- Contractor's Name -------------- �---=� ------ ---------------------------License #��_%��--'Phone ---------------------------- Contractor's -----------• -- --•- --- ----- ,- Installation will serve: Residence partment e� Commercial :❑Trailer Court ❑ Motel ❑Other --- �-c '�----------------- I -- Number of living units:--- )----- Number of bedrooms ------.-----Garbage Grinder ------------ Lot Size ------------ r P;i vate� Water Supply: Public System and name ---------------- - ------ - - -" -- " " - - ----•---------------- Peat Sand Loam ElClay Loam Character of soil to a depth of 3 feet: SandX Silt❑ Clay ❑ ❑ Y i Hardpan ❑ Adobe-F1 Fill Material ------------ If yes,type --------------'- 'l (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,) SEPTIC TANK -!; f Size -----T Liquid Depth - PACKAGE TREATMENT I ] f t � k nn . U Materidl o. Compartments -- ----- -----•--; r Capac, y Type = If Foundation -/--Jo_------------ Pro Line .--_-- '-- 1------ + J{ Distance to nearest: Well -----,/( __l1-- -------- ----- P `d LEACHING LINE [ No. of Lines ----------- ----------- Length of each line-----fa--------------- Total Length ------•-;--"••-------- }} t� 8- ------ D' Box-W-4! Filter Materialvepth Fitter Material I G°L% I--- Foundation-�". -=�Q=---==- Property-L-ine=�.�-----• ------=-- Distance to nearest: Well " ___________ ____ � SEEPAGE PIT [ ] Depth Diameter ---------------- Number --------------------------)Rock,Filled '14 1 `fes ❑ No �[ p ---y-----Rock Size ---------:r..----- -------•--- . Water.Table Depth Distance to nearest: Well ----------------------------- ---.Foundation - 3 ,Prop Line w�:. # . i -� � ---�_" Date t^_�" ,-j-_.�.. � Ix , RIEPAIR/ADDITION(Prey_Sanitation Permit-# --------------r;�------ 1 ------------ ---------------------------- --- �------- `� Septic Tank (Specify Requirements)..------------------- ----------------------------------------------------- , ,-I �---- -- -%�` Disposal Field (Specify Requ€rer,�ents) _ _______________ j- ( + ----------------------------------------------- -- ------ - --- ------- � _ - Vuc--Va E�(O_.moi_ AA'' - • � A. - - ----------------- .w { (Draw existing and required add' on on reverse side) C ! hereby certify,fihat_! have prepared this.application� and that the work will bedone in accordance with Son 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 performaAce 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 ----------- •-------------- Title '------------------------------------------- -- r r (If other t owner) FOR .DEPARTMENT USE ONLY ✓ APPLICATION ACCEPTED BY _ __-- -- DATE f ---_!1 _r BUILDING PERMIT ISSUED -------------------------------------------------------- ------------"---------------- ADDITIONAL COMMENTS ------- ------- - ----------------------- ----- ---------- -----------------------`------------------- -------------------------------- --------------- ------------- -------------------------------- ------------------------------------------------------------ -€ - r - ------- ---------- --- - a ----- ---------------------------------------------- ----------------------- -------------- ---- l - - -------------- ------------Date -- Final Inspection by -- ------------------------------------------------ SAN ---- ---------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M T� ri