72-345 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITA1 N PERMIT 17 (Complete in Triplicate) Permit No. Date Issued '"7.�---- ________________ _ -- - - __ _ __ _----- This Permit Expires 1 Year From Date Issued Application is hereby 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 ADQRESS/LO TION'. ---_/. /fi+ ---------------------------CENSUS TRACT ------------------------•- �r M Owner's Name :-4 �'..��- - -- r = -n[ t� It- Phone Address -----------f-.3-Lt - - -------- - --- r---- -------------------- --- City 1------------------ .... Contractor's Name - ----- d -------------------License #f ------ Phone Installation will serve: Residence ❑ Apartment House Commercial[]Trailer Court Motel ❑ Other ---- -��-` -��-: _ ----- 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 .Q Peat❑ ` Sandy Loam C1 Clay Loom.0 Hardpan ❑ Adobea❑_ Fill Material -----.------,If yes,type ---------------------------- agtk. (Plot;p[an, showing size of lot, location ,of_system-yin relation to wells, buildings, etc. must be placed on reverse side.) .� .` r NEW INSTALLATION::J µ(No septic tank or seepage,'Pit;permitted Xf public sewer i.s available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK K, Size ----------------------- Liquid Depth _-_ —Y------.---.. I _�- k T �? Capacity��_�__,-- Type _-��_1____-��Material__Ll}�/+`.-�---_- No. Compartments ______________________ iDistance to nearest: Well -------------------------- _-----Foundation ------ Prop. Line LEACHING LINE .PC No, of Lines __..-I- ---- _.Length. of each line_"__ � _*`-.-_--- Total Length ---- Q_--------.._..- ef 'D' Box ------✓-.-- Type Filter Material I`+��----_--.DeOth Filter Material ----- - ------_:--_.............. ''c :.... 4- Distance to nearest: Well __ ;---:----:_-__�- Foundation .- -D t f _ Property Line -----------------I...... SEEPAGE PIT t� ; ,. -�,ry 3. - . `Depth -_ ....... Diameter Diameter Number .__- •.=-.,- _- ' _ Rock Filled Yes No p _ �-f.> .Rock Siz • � �t 4. Water-Table Depth ;�-_ Num i e '� --- -`�------- ---------- / ------------- -'....Foundation � p. 6 ------- �' Distance to nearest: Well -------------------------'-- _1__-- - _ Pro Line .-------•--.-.•---•..-- k:s.1; � REPAIpRJADDiTION(Pryv. ganitation Permit}# _ � �� - µ - --------------_-- Septic - Se tic Tank (S`ecif Requirements) ------------ Disposal Field(Specify Requirements) ------------------------------------ ' ------------------------- - --------- ------------- - - ------------------------------------------------------------ - ------------------------ Y ------------------ ------------------------------------------ -------------------------------------------------- --- -------------------------------- ----------------------------------------- ---- - (Draw existing and required.additon onr ireve ise side) I hereby certify that I have prepared this application and ah at Ithe-'wo'rkiwill;bie done in accordance wish San Joaquin County Ordinances, State Laws, and Mules and Regulations of the San'Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: ,� `,_q i "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 to Workman's Compensation laws of California." Signed --------------------------- ----------- - ------------------------------ Owner BYr Title ' ------------------------ -------------------- —(I oth6rr ri-owner)' —�-. ARTMENT USE ONLY. APPLICATIONACCEPTED BY -------- ----- - - - - - ----- ---------------•---------------------------------- ------- DATE ---- => ---------------- 1 BUILDING PERMIT ISSUED .----- °sl �i t:_ *. t ; ------------DATE ------------------- ---------------------- - ---- --------------------------------------------- - ADDITIONALCOMMENTS ---- ------ -------'------------------------------=-------------------------------------------------------------=--------------------- -_ = -------------------- ------------------------ - --- - --- ----- -- ----------------------------- -------------------------------------------------------- Final Inspection by: --------- ----- --------- --------------------------•--------------------------------------Date ------`��T'��= ----------- x AN AQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Re . 5M