71-076 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT / �J�f/' `" Permit No. _,e11`(!_L.C7 (Complete in Triplicate) /� -----�-ry-=-------,-r-� 7 Date Issued . This Permit ExpireV1 Year From Date Issued -------- ".__1 ---------------------- Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein described. This application i�rpa[e in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ._ b ---- 1�X-�'-1r�� c-t ��--- -----------------------CENSUS TRACT ---------------`-----=----- , Owner's Name ---I -------CC.c- ----------------------------------------------------=-I-------------------Phone Address �f� s_.1� ------ -- --------------------------- city City - '-. �a-------------------------..__ ' ' s4 O Gi�4"y -- - Y —.License e� _.- �.JPhone Contractor's Name _ �.- --_ - Installation will serve: t Residence [`Apartment House❑ Commercial ❑Trailer Court ,❑ Motel F] Other ---------------------------- ----- j x r Number of living units:_________`__ Number of bedrooms ____Garbage Grinder _. Lot Size ----------------______________-____-____. Water Supply: Public System and name ---------------------------------•--------------------------------------.--------------------------------------Private Character of soil to a depth of 3 feet: Sand'[ Silt❑ Clay ❑ Peat❑ 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 permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK; I-' Size____ 6_�_ ---- ---------- Liquid Depth ____._-____________ Capacity � 4.0----- -- Type ___`-- --�G-2. Material- - - No. Campartmenfis -.----- `� Distance to.-nearest: Well ----46D----------------------Foundation _.� _ Prop. line ./� -__ -e �� LEACHING,LINE [ ] No. 6$�lines :------�2 ------------- Length of each line---.- -----___.-_.-_- Total Length __�_ ................. r Material I -�11"D' lox ----__ _ Type Filte �R �e th Filter Material ti Distance�to.nearest:.Well..-._-e__=-�..-k-Foundation-_.----10-- ..=1___ Property Line ---.J________-_--__� r � SEEPAGE PIT [ ] Depth; ____ Diameter ___ Number-_. -------------------L__' Rock Filled Yes ' No , W Table Dep#h ---- _- ` ° Rock Size - - -----._._ 4 -- -•- R k i Distance to nearest: Well'__::". t______________________Foundation Prop. Line - REPAIR/ADDITION(Prev.EScinitation Permit# ----_-__--_------------I------------------ Date _______._.______________--_-_----1 Septic Tank (Specify Requirements) ---------------- ------------------------------------------I----------------------•---•-1-------------------------•- Disposal•-Field ISpecify Requirements) ---------------------- -----�--- -------------- ----------------------------------------- . 1. ._! -!+ - _ r- ------------- . .,3�i 1 I-------------------------------------- -------------------- i ---------------- -- -------- ---------------------------------------------;---------------------------------------------------- -------;------------------------ ----------------- i (Draw existing and required addition on reverse side) - ' I .hereby certify•.that l 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 cekifies the following: "I certify that in the pelrformance of the work for which this permit is issued, I shall not employ any person in such manner I as to become subject to Workman's Compensation laws of California." Signed ----------------------------------------------------- --------------------------------------------- Owner ------- Title ------------ ------- - ------------------------------------------------- �flfoha ow ` FOR DEPARTMENT USE ONLY APPLICATION:ACCEPTED BY - --- - - 15-------M--------I--- --- ------ ----------------------- DATE ------ ---------------- >PUILDING PERMIT ISSUED -----------------------------------------------------------------...-------------------------------------DATE ----------•----------------------------- ADDITIONAL COMMENTS ------------- '___________ Tfk :.a _ - - r= ----------------------------- --------------------------------:------ -- ----- - ------:---------------------- ----------------------------------------- - ------------------------------------------------------------------------------------------------------------------------------------------------------------ t ______________________________ _____ ------------------------_ ------ _ ________._______________-__.____--------____-________________________-_____ _---- -y Final Inspection by: r �----- ' - ----- Date ' SAN JOAQUIN LOCAL HEALTH DISTRICT �y E. H. 9 1-'68 Rev. 5M +' t L1/ A4 W Y �'