71-869 - Laserfiche WebLink

Home Browse Search

.� yam/ FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT--- - / . -_7�..--9`-- (Complete in Triplicate} Permit No: 7.� -------------- Date Issued tvThis Permit Expires 1 Year From Date Issued Application is hereby made to the San JoaquinLocal HealtFi District fora per 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 --- ------- ----------CENSUS TRACT -------------------------- ,,__63 - --- - -------- - Owner's Name *4� - 'Phone Address '] -.-CItY "` 7 ---- ! 3 ~ ♦. r., wi fi I Contractor's Name 4`? I- License #f - Phone �Jf� Installation will serve: Residence KApartment House.,❑.Commercial :❑Trailer Court '❑. Morel ❑Other . .--------P------------------------------- Number ,_ - 4 Number of living units:--.--y Number of bedrooms ...Garbage Grinder--------.-_ Lot Size ---------j-__----------------------------- � Water Supply: Public System and name '--------ft - -----"--'-'-•----------------=-------- k--==--------...---------------•------------- Private ❑ Character of soil to a depth of 3 feet. Sand'❑ SiItI--] Clay,] Peat ff'Sandy Loam •❑ Clay Loam Hardpan ❑ Aclobe,15L Filwl 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.) Qq NEW INSTALLATION: (No septic tank or seepage pit permitted-41f public sewer is available within 200 feet,) 41i t y, C 7 i [ 7 t ---•----- `---------- Liquid Depth -------------------------- 1 ---------••-------------- 1 ------ - - --- PACKAGE TREATMENT SETIC TANK' Type Size-- T { . T e ---------.---- Material--------------'711,- No. Compartments -------_------_--- Capacity �' Y -- _ Pro Line [ l ---- ------- Length � � - p. Distance to nearest: Well Foun ation�e--- _- LEACHING LINE No. of Lines gth of=.each;•line.�.--------------- total- Length ------------- -- D' Box -------- --- Type Filter Material'• _ _-- -j--_--Depth Filter Material \i----------------------------------------- f y Distance to nearest: Well ------------------------ Foundation , ------ _- _ __ Property Line A'"- - .. SEEPAGE PIT [ ] Depth ________________ __ Diameter _--_--_-_--:— _- mber'T --------- -------- RoliftckrFilled Yes ❑ No ` t Water Table Depth ------------------------------ ----------- - Rock.Size.------_ Distance to nearest: Well ----------_--------- ------------------Foundation -_ ---_{-----_._-- Prop. Line --_-----__..__-_--__. REPAIR/ADDITION(Prev. Sanitation Permit'# -------------_--------------i--------------- Date ---------------------- ..-__-_-____j Septic Tank `Specify Requirements) = ----F��t _.. f ---- ----- ------ Disposal Field (Specify Requirements) ---- -- Q e f `" 4 ' ` ` ------------- ----------�--.-------- ---------- ----------------------------------•----- --------------- -_. :- ----------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------".------ 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 Son Joaquin County Ordinances, State Laws, and Rules' and Regulations of the San Joaquin Local Healh District. Home owner or licen- sed agents signature certifies the following; "I certify that in the performance of the work for which this p rr*tit-is issuedri'shall-'not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed -------- - -------- --------- -- # ------ Owner (If other n owner) FOR DEPART ENT USE ONLY )) APPLICATION ACCEPTED BY --------(- ---- - �J- DATE :-2 --- - ------------------ BUILDING PERMIT ISSUED ------------------ ------------------------- - - --------------------------- ----------------------------------- -- -- � , DATE ------- ADDITIONAL COMMENTS --------------�-- --------- --------------------------...-_------------ ------ - - ----------------------------------------------------- --- ---"------------------------------------------------ ---------------------------------------------------------------------------- ---------- Final Inspection by ---------------------------------------------------------------------- --.-,Date --""-� - ----------_•------ SAN JOAQUIN LOCAL HEALTH DISTRICT ,i E. H. 9 1 '68 Rev. 5M -111