70-906 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ----- - ------------------------ ------------------ - Permit No. _--------- (Complete in Triplicate) - ---------=--------- - --- - -- �}� - ----------- Y ` Date Issued7a __________________ ___._::_t., . ay... ._,____-- This Permit Expires 1 Year From Date Issued Application is herdby 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: JOB ADDRESS/LOCATION ./.'7--?-!7 .._oQt� T7 --- p��_______._____________CENSUS TRACT ..____`J_ . /___. Owner's Name ---6' 11 Phonjot ____ --------------- Address Q -----•- Address -------1 1 ^-S�_ o / ll !/✓ P/ ,� -_ Cit .;00VXW_7:5- -------------------------------------•---•-- Contractor's Name -- 72-Xl—b i0- ------------------------------------------- --------License 47[� ,3. G---- Phone Installation will serve:: Residence4<partment House[] Commercial ❑Trailer Court ;❑ Motel ❑Other--- ---- ------------------------- Number of living units:___�____ Number of bedrooms _____Garbage Grinder --- -- Lot Size Water Supply: Public System and-name '----° _- --- - ------11-------- ------- ----- -----------------------------------------------Private Character of soil to a depth of 3 feet: Sa'yvt` SFIt❑ Clay `❑ Peat❑ Sandy Loam ❑-"m Ciay Loam;❑ Hard an ❑ Adobe ❑ Fill Material ____________ If yes,type __-_________.___________ (Plot plan, showing size of lot, location-of sy$tem in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank Pr seepa' aa pit permitted if public sewgr is ava�bje within 200 feet,) '` `` PACKAGE TREATMENT [ I SEPTIC TTANJK`J Size ____ _ ___-_______ Liquid Depth _ _................. Capacity/ZV ------- Typey%2':_;;_9W_ Material(iVe0eW� No. Compartments-................. s � Distance to neOrest: Well ___tR�___________--------------_Foundation 149--_____________prop. Line ___.______._._......__ LEACHING LINE No. of Lines 7�j7-G�I,, [�' __ _________________ Length of each line_-��_________-______ Total Length �_7"�................ � Q /� 'D` Box ��__ Typo Filter Material��.___-Depth Filter Material/3?s f Jr Distance to nearest: Well --- -------- Foundation -�____.-------- Property Line �-----_--------- -SEEPAGE P4.T-- -._-._--•_-_-___-SE'1 PAGE-RIS- ) -peipth '_:::__�_. iameter ---------------- Number ______________ Rock Filled Yes ❑ No C ' ..,_. Water Table ------------Rock Size -- --------------------------- yDistance to nearest: ieJI ________ _______ _________________Foundation -------------------- Prop. Line ................... .-4tPAIR/ADDITION(Prgv. Sanitation Permit#__________________________________________ Date __________________________________) Septic Tank (Specify' Requirements) ----------------------------„_________________-____-__-_ DisposalField (Specify Requirements) --------------------------------------------------------------------------------------------------------------------- --------------- 3 --- -----?" / % " - ;7-� ° -5"ys` , r T c7.0 P •C``X--STi.+il � --.t i -- --- ------------------- --------------- --------- ----- --- ------------------------------------------ - -------- --- ---- -- (Draw existing and required addition on reverse side) jihereby 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 agerauilgr Lure certifies the following: "I certify that in the-performance of the work for which this permit is issued, I shall not employ any person in such manner as to become subject tb Workman's Com pen0atiarrlaws of California." ' j Signed ' ° ---------------------------------------------------- Owner BY ------------ -- b < ( - Title _ lG�° ii )----------------- (if other than owner) I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---- =�'----------------------------------------------------------- ----------_. DATE -----L.2 ---------- `-� -------- » BUILDINGPERMIT ISSUED ------------------------- -------------------------------------------------- -----------------------------DATE ------------- ------------------------ --- ADDITIONAL COMMENTS = - --------------------- ------------------------------------------------ -----/ - -----------------i-- -- ---------•------------------------------------------------= ------------------------------------------- -- --- ----- - -- -- - -------------------------- --------------------------- -------- - ------------------- 1 -------------------------------------- ---- - -- ,r., Final Ins ction b - - --------------------- - bate `j - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M