69-409 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE APPLICATION FOR SANITATION PERMIT --------------------------------------------------- Permit No. (Complete in Triplicate) ---------=---------------------------------------------- Date Issued --------------- -_ --- ----------- ----- This P,.e mit Expires 1 Year From Date Issued - 250— 140M..17 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 m de in compliance with County Ordinan a No. 549 and e i ting Rules and Regulations: '7501 r r JOB ADDRESS/LOC ON - ----- ------- - - �""f 'S D °� CENSUS TRACT ------__-- d t -- ------- ---Phone fir✓ ------ Owneri s Name -_dll /G•-- ------------- - --------- Address ------------------ 7 � ----�---- City = Contractor's Name - --------- - --- - �-_.License # a--- 1? ---- Phone -- ------------------------ Installation will serve: Residence ❑i partment House'❑ Commercial:°frailer Court ❑ Motel ❑Other -------------- Number of living units:------------ Number of bedrooms _Garbage Grinder ------------ Lot Size _ -S-U--x-°�-3-�-/- Water Supply: Public System and name ----------------------------------------------------------------------------- ------------------------------- -Private Character of soil to a depth of 3 feet: Sand❑ Silt o `Clay ❑ Peat❑ Sandy Loam C❑ Clay Loam ❑ Hardpan ❑ AdobeX 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,) 1' PACKAGE TREATMENT ( ] SEPTIC TANKM' Size- ------------ Liquid Depth -----:iK--_-_--_----- Capacity R-0-0----- Type(ol Material_- ----_ No. Compartments ------9;--.__.:.... Distance to nearest: Well ...1:�'a_------------------------Foundation -- Q------------- Prop. Line .---- ��s � r h LEACHING LINE No. of Lines _--C?---------------- Length of each lli/inal�-.-,S�-�.---_-- Total Length -/ 'U_..-._-.-_-- 1� 'D' Box ----- __ Type Filter Material-71hK jj__Depth Filter Material _---__�_4'-_��--------------------- f Distance to nearest: Well Z4,0......7___ Foundation �_-;5— -.-_-___-___ Property "Line___________ ____________ SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number ---------------------------- hock Filled Yes ❑ No WaterTable Depth ------------------------------------------------Rock Size -------------------------------- Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ------_-_--._.----- ' REPAIR/ADDITION(Prev. Sanitation Permit# _--_-__------------------------------------- Date -------.--------------------------) SepticTank (Specify Requirements) ----I----------------------------------------------------------------------------•------------ -----------------I----------- --------------- DisposalField (Specify Requirements) ------------------------------------------------------------------------------------------------------------------------------------- s ----------------------------------------------------------- -- ---- - ---------------------------------------------------------------------------- ----------------- (Draw existing and required addition on reverse side) I 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, I shall not employ any person in such manner as to bec �e sub)ect to WorkmdA's Compensation laws of California." Signed -k - - ---'�------------------ Owner BYC • ---- - - -------------------------------- Title ------------------------------------------------------------------------ (If other than owner) x � ,r FOR DEPARTMENT U. E ONLY APPLICATION ACCEPTED BY ----- ----------- -----. DATE ---�-'�-''r'-1____------------------- ---------- --------------- - - --- - - BUILDWG PERMIT ISSUED DATE ADDITIONALCOMMENTS ----------------------------------------------- ------------------------------------------- ----------------------- --------------------------- '" -------•---------------------------------------------- ---------- --------r----------- ------------------------------------------------------------------- -------------------------- ------------•---- -- t ----- ------- -- OHLTH ---- - - - - - Final Inspection by: -------------------------------------------------------------------- - - --- ---- --------Date ��r �� SAN JOAQUIN L D Rl E. H. 9 1-'68 Rev. 5M sk