69-506 - Laserfiche WebLink

Home Browse Search

OR OFFICE USE.= t APPLICATION `" " FOR SANITATION PERMIT -------------------------------- ---------- (Complete in Triplicate) I� Permit No: . This Permit Expires 1 Year From Date Issued " Applicatil��n is hereby Orl,67 describedE Y made totheSan Joa Date issuedThis application is made in Joaquin a�'+iHe lth District fora ��' permit to construct and install the JOB ADD ESS/LOCATION .- /' ` county rdinance No. 549 and work herein Owner's 1-- � ,['' xisting Rules and l ameRegulations:. Address ..�" � e =r- '�= CENSUS TRACT �N C. --- Contractors Name ................... - --------- -----=---------------------- - �. City Phone ------------ --------------- Instal ---- - installation wit! serve: rr' -----------License Residence .�� ------•-----------r Apartment House,❑ Commercial. Phone „ Number of jlivin Motel ❑Other------------------ ❑Trailer Court ;❑ g units:-- Water Su Number of bedrooms pi?�: Public system �----•Garbage Grinder i Y and.name ------------___ IVP-- Lot Size,? Character of soil to a depth of 3 feet: f TM-- Sand ' -------- --- Silt 0 Gay ❑ Peat -------------Private, i " lf Hardpan ❑ Adobe ' Sandy Loam 'L] Clay-Loam �] (Plot plan ❑ Fill Material -_"-_ sli��owin yes, type -----------------i�. g size of lot, location of NEW INSTALLATION: system in relation to wells, buildin s, (No septic tank or seepage pit permitted if g . must be PACKAGE TREATMENT placed on reverse side.) ] SEPTIC TANK.[ ] public sewer is available within 200 feet,J I Size- I Capacity ----------------- ------------- Liquid Depth" Type -------------------- Material-- --- -- - p h ------�------=•----- -•- Distance to nearest: Well --_-_- ---------- No. p -- LEACHING LIN Compartments --_-_-_ ------------- line---- -------- Prop. Line ---------•_--=-- •- 'D' Box - --- -- ------------------- ---- Total Length -- Type Filter Material -_________- -----Depth Filter Material ---------- Distance to nearest: Well _-_ SEEPAGE PIT � ----------• -------•----•--------- ,� r�) Depth _ _ --------- Foundation --------- --- Diameter Property Line -----•- - Number Water Table Depth - Rock Filled Yes .0 No Rock Size --------- - --- 1 Distance to nearest: Well ____'---------------REPAWADDITION(Prev. Sanitation,Permit# Foundation -------------------- ' --------------------- Prop. Line ".__�:' Septic Tank (Specif Re --------------------------------- Date -------- - ----•---.. Y Requirements) ) Disposal Field11 �l (Specify Requirements) . " " ----- ;� -- k ----- --------- = --------------------------- ____ (Draw existing and required addition on reverse side F hereby cern --------------- J fy that f have prepared this application and that the work will be done in accordance } County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local f sed agents signatiI certifies the following: with San Joaquin "l certify that in'tli�e performance of the work for which this permit is issued I Health District. Home owner or liven-~� as to became subject to WorkWown-er '0:0 ' pen, laws of California.- -- f shall not employ any person in such manner Signed ------ Il' ------------ ----------------------------------------- Owner $Y ------------ ot.l�er tha .Title ----------------- APPLICATION ACCFOR DEPARTMENT USE ONLY EPTED `UILDING PERMIT ;TISSUE J-. --�--- ------ - ------------------------- --- DITIONAL COMMENTS ------------ -------- ------------------------------------------- --- ----- --- - DATE - - ---- ------------ ---- - ------ -DATE --- --- ---------------------------------- -- - - - --------------- -------------------- ------------------------------------------------ -- ---------------- --------------------------------- --------------------------------------- -------------- ---------- -- - - --= Inspection b ----------------- --- --- ----------------------------------------------------------------------------------- Y` ' Ci - - (� 1 " SAN JOAQUIN LOCAL HEALTH DISTRICT-------------Date ------ 1-'68 _1-'68 Rev. 5M