69-454 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ,. . T )I so Permit No: - ----------------------------------------------- (Complete in Triplicate) ----------------- - - - - Date Issued -01 • This Permit Expires i Year From Date issue --------- ------------------------- -------- Sn Joaquin Local Application is hereby made to e o t� in complian ewith County yOrd Ordinance permitrict for a install No. 549 and existing Rules and Regulations: described. This application l ---CENSUS TRACT -------------- ------ Qc ------ -- ., JOB ADDRESS/L ON .---- r �p " _ w � c_.t�+, Phone ` t�� --------- . Owner's Name _ Q --- — tom f M 7--------------- City ----- -- ---- - - -------------------- ------------------- Address --- ------ - - '- �_-A_-ZLicense # AZ-MZJ----- Phone Contractor's Name ---------------- - - - Installation will serve: Residence ❑Apartment House^❑ Commercial�',frailer Court ❑ Motel El Other ---- -------- --------------- # rba a Grinder ------ Lot Size / Number of living units------------- Number of ro s , I Water Supply: Public System and name -_- - _--- _ • -------•-Private ❑ t Char6cter of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay E] Peat E] Sandy Loam ❑ Clay Loam El Hardpan ❑ Adobe Fill Material ------------ If yes,type -----------------------__ (Plot plan, showing size of lot, location of system in relation to wells,f buildings, etc. must be placed on reverse side.) Q NEW INSTALLATION: (No septic tank or seepage pit permitted if py blit sewer is available within 200 feet,) i ��/ t - Liquid Depth -------- ------------ PACKAGE TREATMENT ( ] SEPTIC TANK Sze___------ --:-• Q -- No. Com artments ----- --------------- Capacity F fl Q: TYPet'/-V _ Materia! P , ---- =-- ----------Foundation --- - -----------.Pro Line . Distance to.-nearest.. Well - �""--"""- p' / _ Len th of eat line � Q--�---- Total Length __ .. LEACHING LINE ' No. of Lines -----I--- -------- 9 ' J'D' Boz ------------ Type Filter Matenal�!_ _��-Depth Filter Material �,�------------------f i -- Found //Foundation ___" -_ Property . _* Distance to nearest: Well --- i �--�- - -- _- Pro P � Line ------------ 1. ,�- --------------/-_ of */ Rock Filled Yes No .0 i SEEPAGE PIT � Depth __- .- _-------- Diameter a3 Number Water,"' "Depth ----- d' Rock Size ---- -e� - -------------------------- - i - Foundation -------------------- Prop. Line ---- ---------•------- Distance to nearest: Well ----------------------------• - ---- --- --- -- Date�--------- ----------- --------1 REPAIR/ADDITION(Prev. Sanitation Permit F# --------."------------------ I ---------------------------------- ---------------- Septic Tank (Specify Requirements --------------------- ----------- -- -------., Disposal Field (Specify Requirements) ------------ -- ------- i-------,------�-- ------------------------------------------- -------------------------------------- -------------------- - ------------------- - - ---------------------------------------- ------------------------------------------------------------------------ (Draw existing and required addition on reverse side) I hereby certify that 1 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 perforMa a of the work for which this permit is issued, i shall not employ any person in suchmanner las to be a �j c to �19'or an's Compensa011 '.on laws of California."'W Owner Signed - , .+ Title -- --------------------------------------------------------------------- BY '. (if othe than owner) FOR DEPARTMENT USE ONLY *�A� -` ----------- Q-Li--------------------------------- ------------ ------------ DATE -- --- 1 APPLICATION ACCEPTED 8Y ---------I!V-- - - - --------------DATE --------- --------- ----•--- BUILDING PERMIT ISSUED ------------ -- -- ADDITIONAL COMMENTS --------------------------------------------------------------------------- - -------------- E ----------------- ------------------------- ----- --------------------------------------------- --- ------ ------------------------------ --------------------------------------------------------------------------- - / s Final Inspection by: ------------------------------------------ -' ---- - - Date s SAN JOAQUIN LOCAL HEALTH DISTRICT - I E. H. 9 1-'68 Rev. 5M.