70-803 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ---------------------------------1---------- - Permit No.7 (Complete in Triplicate) � ��- �/�- :- --------- This Permit Expires 1 Year From Date Issued Date Issued f d_-_�7 _'.7d Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work her described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: 70V `s - JOB ADDRESS/LOCAT N . �f' - -------------------- CENSUS TRACT Owner's Name --------------------------------- -------Phone ------- ---------------- Address ------------ Address -------------AY4 ----- -----------. C�tYc --------------------------• --------._....... Contractor's Name ------ l f 2A-,-k-- -'_--------.License # 111.3Phone ---------------- Installation will serve: Residence �partment House Commercial ;❑Trailer Court 'F]$I Motel ❑Other -------------------------------------------- ,Number of living units:------i Number of bedrooms __A------Garbage Grinder ------------ Lot Size ____________________________________________ Water Supply: Public System and name -------------------------------------------t -L_-----------------------------------------------Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam 09 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 { ] SEPTICTANK!P-� Size_q - ----_X-f--X-"f • ----------- -- -- - Liquid Depth ---�'�---------------- ----- q Capacity _9_a1_141 Typed [R ______ Material_ ------ No. Compartments Distance to nearest: Well ____________ _ _ ____'" __Foundation____ -- r______ Prop. Line ___-_ __�____l..__ LEACHING LINE ,,/Distance of Lines ____._ _ ' ____ _ __ Length of each line________ _ j g jj f Total Length .! .®-------------j 'D' Box ----. ----- Type'-Filter. Material ____ -•- '----Depth Filter Material ---_ ------- ---------------I.... 01 Distance to nearest: Well ' _ d-+ -�.__ �-_ f=oundation _______I�_�________ Property Line __Jr�..............._.._._.- SEEPAGE PIT [ ] Depth -------------------- Diameter �' 7[:]_-------------- Number ---------------------------- Rock Filled Yes ' No i❑ 6 .f I Water Table Depth_ji-----------------------------------•-----...Rock Size -------------------------------- Distance to nearest: Well ________________________________________Foundation -------------------- Prop. Line -----............!.... REPAIR/ADDITION(Prev. Sanitation Permit# ____________________________________________ Date ________-.:_.----_-__--_______-__) SepticTank {Specify Requirements} --------i------------------------------------------------------------------------------------------------------------------------------I.... Disposal Id (Sp cify Requirements) f------.--------------------------------------------------------------------------------------------------------- -------------------- i r, ------------------------ ------------------------- ------ ,------------------------------------------- i ----------------------------------------------------------------------------------------------------------- ---- - (?raw existing and required addition on side} j - .- ._ I hereby certify that i have prepared this -application and.that the?work .will be done in accordance with Son Joaquin F County Ordinances, Stat4b Laws, and Rules and'Regulations of the San Joaquin Local Health District. Home owner or licen- t , t sed agents s�,.ignature certifies'the following — - ? "i cr. ertify that in the 3 erfoi<rimance of i•he work for which this permit-is issued, I shall not employ any person in such manner as to,become=subj V Workman's Cam ensation ilaws' of California.." Sign�d ---------------- --- —----------------- Owner -� P� BY =---------------=- 'L 7 -------------------------- Title .V --- ---- -------------- ------------- I {Ef other than owner} r '� ' - f r f FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY'j x ---------------------------------- -------------------------- DATE l 'yam`-70--------I BUILDING PERMIT ISSUED ------------------------------------------------------------------------------------------- -------DATE -------------•-------- -------------- ADDITIONALCOMMENTS --------------------------------------------------------------------------------------------------- ------------------------------ ---------------------- f f I } ---------------'-- -- ---------------------------------------------------------------------- I - --- _ - - ------- Final Inspection by: '= --------- --------------------- Dated -- � - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M.