69-192 - Laserfiche WebLink

Home Browse Search

1"': �� r' i- R OFI;ICE USE: AppLlCAT10N FOR SANITATION PERMIT _ } Permit o: (Complete in Triplicate) Date Issued ----- iT is Permit Expires 1 Year From Date Issue d h -----_--------------.---_ •� . .�I to the San Joaquin Local Health District for 4a permit to construct.and Inst If the wofk herein Application is hereby made Mules and Regulations: described. This application is made in compliance with County Ordinance No. 5491and ekistirig� ---------------------------------------�`--- =----- �--CENSUS TRACT ---- ----- �--- --- 44 JOB ADDRESS/LOCATION - -- •e --Phone ---------------- ---------- - v _� ..Al------ -_---_-.--__ --�.. —._...� --- . Cit _ �--_ ------------- Address --------- ---------------: ----------------- i License # 1_ Phone Contractar°'s Name=: - I i Re-idencexApartment House°❑ Commercial:❑Trailer Court '0 Installation will serve: Motels ❑Other _ - J Loi Size Nu�ber of living units.__----__--- Number ,of+bedrooms Garbage Grinder i-____� ------------Private . �M i I Nr Water Supply: Public System and name4- f -� Peat El Sandy Loam 0 ¢CIn Loam,❑ Character of soil to a depth of 3 feet: Sand❑ Silt Cl Clay ❑ _�--^ ..T.` 1 l Adobe' Fill Mater d_;i�- —1f.-yes,type ---------------------------- Hardpan ❑ - ' v. F f wt buLlding_s, etc: mus# be placed on reverse side.] (Plot plan, showing s,z� of lot, loc-ation .of ,system-in-relation o�.w,el.ls,.... y NEW iN57ALLATfON�'`0INo septi�t'ank or 'seepage pit permitted if puuljlic-sewer is ovallable��14 ithin 200 faet,j O Size_ Li uid Depth -------------- SEPTIC TAMC;[ ];,f„� ----- --------- --- ------ ---- - •-- - -�, � t PACKAGE TREATMENT [ ] •__� No. Compartments t capacity � - Type ----- -------------- Matenah---- :---= ------ --:---- P Y 14� �`� Pro Line ----------- ---------- Dista ce to nearest: Well ________-------------'--------�-"jFoundation - _>--- p GI ! Total Length - -----------•------•-- LEACHING LINE [ ] Nw of Lines --------- -------------- Length of each line____.__------_---- , 1 __De Depth Filter `,Material -------------------------------------------- 'D --- ---- - --------•----•----------------•- 'D' Box ------------ Type Filter Material _____------- p e Distance to nearest: Well _____________________ Foundation "- �------�-------- Property Line. ------------• l ! --.--�---__-__ Rock Filled Yes ❑ No :❑Depth Diameter ---------------- Number -- ---- SEEPIAGE IT [ 1 P t " _,_,.�.r.... - Water Table Depth ---- ------- -"---------------------------------Rock �z� --------- ---------------- ---- --- Prop. Line -_----------_-----•- i � Distance to nearesti Well .--_--�-- ------•--Foundation -�-------------- p• - -------------- r. .__ _ �}} l Date - -j REPAIR/AQDiTION(? . Sanitation Permit t------------------- -------- =.. y��uirements) -------- i Septic Tank Specif c / _ A --------_- Disposal Field (SpelNify Requirements) ----------- -----•--- --------------``-- ----- I -------------------- req ui ;---'`- - F Edition on reverse.sidej (Draw existin ,andl' wired ��r3 I hereby certify that I have prepared this application and thf tfie San Joaquin Lacale work will oHealth District. Homene in accordance to owner or 1 ceh Son n Cou 4ty Ordinances, Sfate Laws, and Rules and Regulations a sed agents signature certifies the following� p erson in such manner .,'1 certify that in the performance of the work for which this permit is ssuedr I shall not em loy any p as to,become subject to Workman's Compensation laws of California. I Owner signed -------------------- - ---- - 9 - y ---------------------------------------- � BY - ---� --� --- [If ot------ r'than owner)- - NLY FOR DEPARTMENT USE - • iM 3_ . M � ---- -- -------- ----------------- ------- -------- DATE -- l----�-L b�_.__ ---------------- APPLICATION ACCEPTED BY ___- ----F'4,-� BUILDING PERMIT ISSUED ------ ------- ------- --------- -------- -------- ------ --- ------- --------- --•-•----------DATE-------- ------------------------------------------------ ------ ------- ------------•-- -•----•--- -- ------------------------- -------------------- ---------------------------------- --- ADDITIONAL - ADDITIONAL COMMENTS ----- -------------------- �' - ------------fit A -------- ---------- ""'.-- --------------------------- ------------------------- = --- - -- ---------- -------------------------- - �I --- - ------- -= �= __ . ------ ------- -------- --------- --------- -- ---.Date -- ---�- --�- -- --- -- �- Final Inspection by: - _ ---------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 41 E. H. 9 1-'68 Rev. 5M.