68-666 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION Ft�R SANITATION PERMIT Permit No: .- --- 7w-f- --------------- ----------------- (Complete in Triplicate) - ------------ Date Issued This Permit Expires I Year From Date issued ----tom-- `- ---- ------- - r 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 6n&:existing Rules and Regulations: ,per ----------CENSUS TRACT -------------------------= JOB ADDRESS/LOCA N - --------- Owner's Name Phone Address ---- - - -------------- City Contractor's Name 9 ------r------- ----- -- P—License Phone Installation will serve:i Residence Apartment House❑ Commercial:❑Trailer Court C] Motel ❑ Other l = l "PJumber of living units---------I..._ Number of bedrooms _---Garbage'Grinder ----------- Lot Size ------------- --- ------- -- - - - ? 1 r., -Private d Water Supply: Public System and name ------LI-f_a -- --- A_____CIay,__Lcam Character of soil to a depth of 3 feet: Sand'0 Silt❑ Clay'o❑ rPeat❑ Sandy Loam ❑ Adobe,[;] Fill Material ---- ---- If Yes,type --------------= �• Hardpan ❑ --� �- - buildings, .etc. must be placed on',reverse side.) y {Plot plan, showing size of lot, location of system in relation to weds, \ ` p seepage pit permitted if public sewer.is available within 2Q0 feet,) NEW INSTALLATION. {No septic tank or i PACKAGE TREATMENT [ ] SEPTIC TANK [ ] Size.___.-_-=------•------ Liquid Depth ------------------- p, Ca acit ------- Type ---------- lNafierial-------- ------------- ------------- Compartments Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line .----_---- ., "No. of Lines ---------- __--- Length of each' line--------------------- ------ Total Length == �% LEACHING LINE [ ] 1 - - r -------Depth Filter Material --------------------------------------- ------------------ Property ---------- -- 'D' Box __.____..-- Type Filter Materia "-°--__------= A to nearest: Well --------------------- Foundation ---------------------- DistanceProperty Line ------.---------•--= ,. SEEPAGE PIT Depth --- Diameter ......... Number --------------=------------ Rack Filled Yes C1 No ❑ iWater Table Depth -- ------ ------------------- -------------Rock Size -------------------------------- Distance to'neares'#-Well- - ------------------------------- ----Foundation -------------------- Prop. Line -------••-------•--• n ` ate ----- ---------- ----•------ -----) REPAIR./ADDITION(Prev. Sanitation Permit# ------------------------------------ --- I " I 1 -------=--3--='---- ---------------------------------------------..-,�---------------------------- Septic Tank=(Specify Requirements) ------------------------------------------ 1 k _' I - Disposal Field (Specify Requirements)- -- '-=--=---`----•----•------- ---------2,a'X--ZS`j�t'--- --/----- ------- /+ ------------------------- ----------- ----- . ._� .-. --__ -- -- ---------------------------- --.------�__--- -- > -------------------------------------------------------------- { t - {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 f County Ordinances, State Laws, and Rules and Regulations of the. San Joaquin Local Health District. Home owner or licen- t sed agents signature certifies the following: "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 b o subject to Workma Compensation laws of California." Signed ------- --------------- Owner Title --- --- ------ 9 ---- ----- {If other than owner) l t FOR DEPARTMENT USE ONLY r . DATE'.-- �r�' --------------- APPLICATION ACCEPTED BY ---------- E - - -DAT -------- ---------- BUILDING PERMIT ISSUED --------------------- ---- --------------------------------------------- ---------------------- ----------------- ADDITIONAL COMMENTS ---------------- -- -------------------------------- -------------- ---- ---- ------------------------ --------------------------------------------------------------- ------- ------ -------- -- ---.Dater-- --- Final Inspection by. -- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M