69-829 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USER SANITATION.PERMIT permit No:i:0 APPLICATI�N�®te in Triplicate? -- - - -- ------------ -- -------- --------------------- Date issued ------------------- ------ -- p - ------- - -- - This Permit Ex fres 1 Year From Date issue A lication is hereby made to the San Joaquin Local Health District fora p ermit to construct and install the',work herein ppxibed. This application is made in compliance with C aunty Ordinance Na. 549 and existing Rules and Regulations,iatiorn�s.- desc CENSUS TRACT _ --.-- F FJ _ 1 JOB ADDRESS/LOCATION ._-- � ----------------- -------Phone Tf?r _ ®_ - �- -------------------------------- ------------ J' -- Owner's Name D � L _ �_ _D -l--------- -----•----.. City ��G LO - , Address = License # ------------------------ Phone of?7i l �r� ---------------------------- I Contractor's Name _--.__� --------=--- ------ - Commercial .❑Trailer Court '❑ Residence eApartm en use'F] , Installation will serve: //11 ..,..! -, ms ____[ _ Garbage Grin .t _- ----- - Matel ❑Other 14CF �- der _, �---- Lot Size _ L{ Number of living units:.----(_-_-- Number of bedrooms Private ------ :k------------=------- _ Water Supply: Public System and name -__.k .----------<---•-- — ' k r Silt 'Clay ❑ Pepe_❑�and�Loam,Q —Clay C�� - Y Character of soil to a depth of 3 feet5 1�4�,, - -fl e _ __ t Hardpan ❑ Adobe❑ Fill Material _- s�__ if yes,type buildings, etc. must be placed on reverse side.) (plot plan, showing size of lot, location of system•,i t rIerm tted if public sewer is available within 200 feet) NEW INSTALLATION: (N.o.septic tank or seepage p p _---- SEPTIC TANK[ Size--- - --------------------- Liquid Depth -- PACKAGE TREATMENT { 7 No. Com artments Q p yT' m. _t`�4 -_ Material_Cp R� pi L7 3 P Pro Line .------ Catacifi �Inearest: well e Foundation'--�Q --•-- p' , A Distance,ao i ' Length of each line----A :------------- Tota! Length �� 9 Nor of Lines ------- --------- LEACHING LINE "fi _ ��rr - -------- at[0---- TYp 'D' Box a Filter Mate{iai C-1 --._Depth Filter Materia Line d ��_-"--- Foundation �t� ----- --------- Property i---------- k Distance to nearest: Well'- ea---_-- Rock Filled Yes ❑ No .0 ! -------------------- iDiameter = NumbeRack Size - n De th ' Pro Line ------- SEEPAGE [ ] pt 1 Water Table Depth -------- r p l �' Foundation ------------------- ----------------- Distance to nearest: We ----- ---------- - _ _ _ - ------------------------ I _Y� � �!-------------------------- Date - -----•--•--------•--------•-----� REPAIR/ADDITION(Prev. Sanitation Permit# ---•-- - = I- -,__.------------- Septic Tank (Specify Requirements) - ----- ----- -+-- --- -- ----------------- - ' ----------------- Disposal Field (Specify Requirements) - - .------ ------- _ _ - --_-_ _ :___------------- --- -- -- r ... - ------ t •-- f y -- ------ - -------- -- .-,---,----- ----- -- -------- ---- --,, „�� -------i--- -- -- - (Draw aisti g ah required addition on rev side) I hereby certify that I have prepared this' pP - kand that the work' will be done in accordance with San 3loaquin yJ 1 County Ordinances, State Laws, and Rules and Regulations of the San=Joaquin Local HealthrDistrict. Horne owner,or liten- r� sed agents signature certifies the following: k 4 person in such manner permit.is issued, 1 shall not employ any p ; "1 cern#y t t n e performan a oft wor or w.h'ch his p ro>w1a 't fC lifornia." as to be�6eectrk an's C mpe .t l _ `-aOwn l Signed Title~- - ------------------------------------------- { i --- -� �+ By = ell if other than owner) r I' FOR DEPARTMENT USE ONLY i .. _ r ° Q ..-DATE ---`-` -- - ISSUED ------------- �-- - `--- ------- DATE --------------------- -------=---- -------- APPLICATION ACCEPTED BY _-_- - W- ----------------------- ------ BUILDING PERMIT i, " � `` ADDITIONAL COMMENTS- a=J_7'_6 -"--- -- I =-•. _ - -. ---------- _ _ _ _ _ --- _ __ - _ ------ - - Yir' p.c 3 - �. r 4 - - -� - _ _ ------ 1 _.Date _ l Final,Inspecti� on e s SAN nJOAOUIN'LOCAL'_ HEALTH DISTRICT ?. s f . E. H, 9- 1-'68 Rev. 5M