71-024 - Laserfiche WebLink

Home Browse Search

Z[:ANNFD - .y,p� FOR OFFICE USE. 't, 6 �/ X01191 ( ) APPLICATION FOR SANITATION' ,- tMIT.s -------------- ---------------------------------- - s�._ Per No: g 7 ; (Complete in Triplicate) " !/I ------ This Permit Expires 1 Year From Date Issued Date Issued --------- Application is hereby made to the Joaquin Local Health District for a permit to zs!:,? and install the work herein described. This application is ma eI i coplionce }vitt oury#y9rrdiinaannce� h� s ing Rules and Regulations: , �/ t' .� t JOB ADDRESS/ ION ._C�--- --- - C' f --- �C4rfl-�/s� !< - - 7-_CENSUS TRACT -------------------------- Owner's Name -ll <er_ /i�C___4 "Ve...( - ` Phone + �------- Address -------1 -... ----- - Cit j"--- ---------'--'- --•-------- Contractor's ------ ` Name' -------- -- --69Cv.Uel'-----------------------;----------------------.License # ------- ------ Phone .----------------------------- Installation will serve: - Residence X Apartment House❑ Commercial ❑Trailer Court Motel ❑Other ---- -- - -Garbo a Grinder ---------- Lot Sizer ___. - Number of living units____ _______ Number of bedrooms f �,� ��'�___-_�_________________ Water Supply: Public-System and name ___--x-_/'/+�� /�- �c=1/ � Private ------ ---------------------------------------------------------------- Character of soil to a depth of 3 feet:,a Sand'❑ Silt❑ Clay ❑ Peau] Sandy Loam ❑ Clay Loam ❑ � Hardpan ❑ Adobe ❑ Fill Material ------------ If yes,type ---------------------------- (Plot plan, showing size of;lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit ermitted pu lic sew r is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK' (7w_ �' Size �T ------ ---(�-' x- - -------- Liquid -Depth -------'-�------------ ;:. k �,fir,� �.�►► Capacity ---� !--- Type -6/ _ Material- -��-------- No. Compartments -_ -.- ------•-- l �-s'�Distance to nearest: Well ---IM' f-_-_-_----_Foundation .._14I .. f' r Prop. Line LEACHING LINE ] TIa: of Lines -- -------------- Length of each line-------- -----.---.-- Total Length -_--- ..........__.. f p' Box _--~ ----- Type Filter Material r `<_-+ Depth Filter Material ---_-_ _ I`_-_ °�� IAM( t Distance to nearest: Well -__LA - _-_ `Foundation __�. �-- `__ Property Line ----- ---�`-._-_ SEEPAGE PIT Depth --------------------- Diameter ------ -------- Number ---------------------------- Rock Filled Yes ❑ No ❑ 4 Water Table Depth "y} ------Rock Size -------------------------------- b` Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line -.._-_._--------_----- I ' REPAIR/ADDITION(Prev. Sanitation Permit# _-_-_----- ------------------------- Date ---------------_-_..-_-------_-_--) FSeptic Tank (Specify Requirements) Disposal Field (Specify equirements) - - � •.' . - ----- =--- -------- - I �l, -o i-- - --- /c r JC a�,f I ----- --- -- .� - -------------- ------------------------------------------------------------------------------------------------- {Draw existing and required addition on reverse side) I hereby certify that I 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 performance of the work for which this permit is issued, 1 shall not employ any person in such manner %- as to becom ub' t to Workma 's ompensation I s of California." # Signed - --_ Owner BY ------ --- ---------- `- --------------- ............... --------- Title - (If other than owner) FOR DEPARTMENT USE ONLY E, APPLICATION ACCEPTED BY --------- = ---------------------------------=-------------------------------------- DATE 1------------------ ! BUILDING PERMIT ISSUED ----- -- Y DATE ADDITIONAL COMMENTS __! -� � - -- ------------------------------ --- -- Now - ., `'' - _� ---- --------------- - --------- ------ _ � vuz^ -- -- -----------------_ 4 Final Inspection by: L67 '------------------------------------ ---------------------D - e --------PA=3' � SAN JOAQUIN LOCAL HEALTH DISTRICT E..H. 9 1-'68 Rev. 5M