70-367 - Laserfiche WebLink

Home Browse Search

FOR OFFICE'USE.,�, ATION FOR SANITATION PERMIT LIC --- - - -------------------- Koro Permit No. ------------- - - �nz� iriOltatil 7 ----- ----I----------------------' --------------------- I I Date issued This Permit Expires 1 Year From Date Issued fj 14,0 " Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein des riFbPd. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: �06 POOL --- ---CENSUS TRACT " -------- JOB ADDRESS/LOCATION --------—------------ - I 4phone------------------------------------- Owner's Name -----63&-y1fV-e-S---- ------------------------------------------------ ------------------- Address ---------- ---- -----'-------- ------------ city -----------------------------•-----I.....-- Contractor's Nar;e ------- ------------------ -----------=----------------------License # -------------------- ---- Phone ----------------------------- i4 i Commercial Trailer Court Installation will serve: Residence E]Apartment House-F� MotelF1 Other -------------------------------------------- Number of living units:------------- Number of bedrooms ------------Garbage Grinder ------------ Lot Size -------------------------------------------- ----------Private ❑ Water Supply: Public System and name --------------- -- ----------I------------------------------- ------------------------ Character of soil I to a depth of 3 feet: Sand'[] si I it F] .Clay E] Peat El Sandy Loam F' Clay Loam 'E] Hardpan 0 Adobe E] 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,) PACKAGE TREATMENT-- SEPTIC TANK:[ l Size------------------------------------------------- Liquid Depth -------------------------- capacityyp T, -------------------- Material---------------------- No. Compartments ------------------- -- ---------- e Distance to nearest Well -----------------------------_Foundation ----------------------- Prop. Line ---------------------- th of each line-- ------------------------- Total Length ----------------------------- ---------- --- Len LEACHING LINE No. of Lines t- —�"- .- Z.- I l 'D' Box ------------ Type Filter Material ---------- -------Depth Filter Materia- -------------------- --------- ----------- Distance to nearest: Well ........!9---- --------- Foundation ------------------------ Property Line ------------------------j I SEEPAGE PIT Depth -------------------- Diamiiter.� ---- ---------- Number ---------- ----------------- Rock Filled Yes [I No -------------!------ Prop. Line --------- ------------- Distance to n6arest-. Well --- ------------------------ 11P --------Rock Size ---------------- Water Table Depth ---------------- --------------------- ---------------- ------------Foundation REPAIR/ADDITION(Prev. Sanitation Permit# ---------------------11--------------------- Date ---------------------------------- Septic Tank {Specify Requirements) ------- -------------- - --------- ---- -------- -----------------•---------------------------.----- V ----------------------- Disposal Field (Specify Requirements) X ----------------------- ---------------------- ----------------- -------------------------------------------------------- ---------- ....... --------------------------- --------------------------------------------------------------------------------------------------------------------------------------I---------------------------------------- ! (Draw existing and re wired addition on reverse side) accordance with San Joaquin ' I hereby certify thathI have prepared this application and that the work will be done in d 'ulaons of the San Joaquin'uin 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, I shall not employ any person in such manner as to become subject to Workman's.Compensation laws of California." Signed ---------- -----------------------S: ------------- Owner -- --------- ----------- • i Title BY ----------------------- --------------- - ----------------------------------- ----------------- --------------------------------------- (If bth�e,�'-,ih �owner) P—A I FOVI)EPARIMENT USE ONLY DATE ?c� BUILDING AOSE I-Ep. BY --- --------------- ------ --------- -------------- --------------------------------------- I -t --DATE ------------------------------------------- BUILDING PERMIT'ISSUEb --------- ------------------------------- II -------- ------------------------------1-1---------------- ADDITIONAL COMMENTS --------------------------------------:------------------------ -------------------------- ------ ---------- -= �--- --------------- --------------------------------------------------------------------------------------------------------- ---------------- --- �------------- ------------ --------------------------------------------------------------------------------------------------------- --------------------------------------------- i ------------------------ - -------------------------------------------------------------------------- ------- --------------------------- -------------------------------------------- Final Inspection by: ----- -2- A ----- ---- ----------------------------- -------------Date " SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M.