69-850 - Laserfiche WebLink

Home Browse Search

'FOR C'FFICE USE: . ,, APPLICATION FOR SANITATION PERMIT ----------------------------2------•---------------- No. __(P -------------- {Complete in Triplicate} Per ______________________________ ----------------- -------- This Permit Expires 1 Year From Date Issued Dae Issued r 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 made in compliance with County Ordinance No. 549 and existing Rules and Regulations: F c� JOB ADDRESS/LQCATION _ :66 7,0 5 1 '} _)_ _ �/ ' __. __--_CENSUS TRACT ___`�___� Owner's Name l R--------fTuFu 5 / l pa-FOA ----------1}--1 i Phone Address ---HW 0-0_47---�V-j� �� --`-a� City ��C��_i' p� �------------------------ Contractor's NameW N ---------------------------------------------------------License # --------- ------------- Phone ------------- Installation will serve: Residence 0 Apartment House❑ Commercial :❑Trailer Court"`i❑ ` p Motel ❑Other -------------------------------------------- , Number of living)units:____)____._ Number of bedrooms .Z--.-_Garbage Grinder _n (1Lot Size ___f-_-_�_ G- Water Supply:'Public System and name ---------------- -----•---------------------------------------------------•------- ------ ...... -----------Private Character of soil to a depth-of 3-feet:- -Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ..,..r_;.._....—Haarrdpan ©! Adobe'❑ Fill Material _hJi0_--_ If yes, type ______._________________._ (Plot plan,slshowing size of--lot" Idcafiion of system in relation to wells, buildings, etc, must be placed on reverse side.) C4 NEW INSTALLATION: (No septic tank 6r seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT f ] SEPTIC TANK [ Size------------------------------------------------ Liquid Depth __________________________ v Capacity ------------------ . TYPe -------------------- Material---------------------- No. Compartments ---------------- j., ell Distance to nearest: Well .'----------------------t------------Foundation ---------------------- Prop. Line ------- .............. LEACHING LINE, [ j No. of Lines --------- ?---____.___Itength of each line___________________________ Total Length ---------------------------- 'D' Sox ------------ Type .Filter Material__' ----------I----Depth Filter Material Distance to nearest: Well -------------------------- Foundation ------------------------ Property Line ---------.._____.,....__ SEEPAGE PIT [ ] Depth ___{_ Diameter __f------------ Number ---------------_------------- Rock Filled Yes ❑ No i❑ `� { 4 Water Table. Depth ------ .- / ------Rock Size ---------------- Distance to nearest: Well .---------------------------------------Foundation:----------------.--- Prop. Line -.-----.__.._---•-- .. REPAIRJADDITION(Prev. Sanitation Permit# €--�--w------------------------------.'_---------- - ' Date ---------------------------------_ s �----------------------------------- )� ;-----.---------i-- ----------Septic mnk (Specify Requirement �Disposal 1 S eis -------- � Ja---------------- -------- ------ - - — --------------------------- ------------------------- ------------- ----- • 9 c _ !�� Y; - -- :�: (Draw existin --and-re uirecl addition cTARverse side) I hereby certify hat I have prepared this application and that the work willbe done in accordance -with San Jaaqu ni„i 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 the ” rForrn ce of the work for which this permit is issued, I shall not employ any person in such manner as to beeo a ubj�ct o Wor an's Compensation laws of California." Signed --- Owper By ---------------- ------------------------------------------- ----------------------- 'Titfe --------------- -'-._---------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BYE ` DATE f� ' 6c = BUILDING PERMIT ISSUED ----)- - - - :.: - =DATE - _ _. ADDITIONAL COMMENTSt �t�:r - - ='.' f _�__ P �_ _ _ : =--F - _ --- ---------------------- �, w � �'�. ---------------------- ---- ----- -------------------- ---- ----------------------------- Final,lfi �� ------ ----- - - - --- -----t------------------(--------------------Date -- --- ---- 1 , SAN JOAQUIN LOCAL HEALTH DIST�ICT E. H. 9 J 1-'68 Rev.'5M