70-133 - Laserfiche WebLink

Home Browse Search

.I w} r FOR OFFICE USE: ' _ APPLICATION FOR SANITATION PERMIT ------------------------------------------------------------ } Permit,•No. -=-�---�-�----- (Complete in'Triplicate) --------=----------------------------------------------- p Date Issued _----_______________ _______________________________• This Permit Expires 1 Year From Date Issued 0&,0•-3 Application is hereby made to the San Joaquin Local Health District for a permit to construct and install th work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: 1Xs_-E7RX1QhOAA ---CENSUS TRACT ---_-- _ 5P----JOB ADDRESS/LOCATIOFR Owner's Name ---CH-114GH-I LQ-------- TCamPi6 � . - ------------ -- -----Phone Address ------ logle- ----- --------------------------------------------- Contractor's Name -----<fi R6-_tLE > _ft� 1 U -----.License # Phone ---------------------•-•-•---- �g Installation will serve: Residence ❑Apartment House❑ Commercial : railer Court ',❑ Motel ❑Other --------------------------------- Number -------------------------------Number of living units:--_'"'__` Number of bedrooms -----_-_Garbage Grinder --------- Lot Size ---------------- VJ--'-- r______ ___ ._-Private Water Supply: Public System and name --------------------------------------------- ---------------------------•---------- ❑ E Character of soil to a depth of 3 feet: Sand b Silt❑ Clay ❑ Peat❑ Sandy Loam -Clay Loam ❑ ; �. _... _ erial .. f e _- - �.� s Hardpan[�a�Adobe..'_ Filf Mat ?YPe _ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.l�,W { NEW INSTALLATION: (No septic tank or seepa pit permitted if public sewer is available within 200 feet,) �r PACKAGE-TREATMENT { ] SEPTIC TANK_[/ _ -- --.___-- Lsqutd Deptf ---------------- Capacity r ----- ype,'P8F--Cf 5F___Material._CRT 47NCNo.. Compartments _.....__-- --. i' t V►1 �Q -.Prop. Line -- -- '�, � �Dastance ;o..nearest: Wel - - ----------- ---- / LEACHING LINE r (r]�No, of Lines ....__l/`..--....___f:`Length of each line ---------------------- Tota! Length ------ LEACHING 'D' Bax (�0-_._t' Type Filter • # W . { :F I Mder-i-ar•f �p�C�i------Depth Filter ar MrIatverti/al �_ , 1r7 ------------------------------------ I ...................................01 i Distance tolfnearest: WellQr --------------Foundation-19- _-_.----Property_Line_.� ................ meeSEEPAGIT Depth DiaRock il�Ed_ YesNo ❑ , c] � , - Size Rock aterTable' Depth .._-3Q . #---- i---------- �� \ Dista ce to nearest: Well ---ff��.Q-.- / ------ Prop. Line:.--•- -_:=-•---___-- i ! _-_...._..Foundation - - f� -- REPAIR/ADDITION(Prey. Sanstatson0ermst#-------------- _ -------- Septic Obte ------•-�--------------------1 Dis os tank (Specify Requireme`ts) ------------------;----------------------'V'--�h-------------------- i-------------------------------_-----------------••-•-------- Se tic p l Field {Specie Requirementsl ----------t----------- = = -------i z = � ... t 1 C. I n w f_ !n JcIC!------------------------- s ------------ ----------- 1-- -. ................ ......-....-_ .._- ..rJ.. y .r v - y S } : . t ---------- ----- - ---------------�- - _. ----= -1---------- w - (Draw existing and required addition on-reverse sided I hereby lertifyLl-al,011 have prepared this,application and that the work will be done in accordance with San Joaquin County O;dinrances,IState Laws, and Rules and Regulations of t9e San Joaquin Local Health District. Homeowner or liven- , sed agents signature certifies the following: -- ') �• ,,, _ "I certify.khat in the performance of the work for which this permit is issued, I sshall1not em RIg oy any person in-such rnanner as to become subject to Workman's Compensation laws of California." Signed ~ By ------ _-' --5 --------- ------------------ ----------------- -Title ------ ---- ------------------------------------------------------------ (If other than owner FOR DEPARTMENT-fUSE.ONLY' { * .�. .-► m . APPI 1C;4TION ACCEPTED BY ---- F 1 .11 AFF---Zfi =l l-r-'%t.,S --- 4 a ri�w -DATE ------- ---'-'•---- BUILDiNG-PEI MIT-ISSUED'_`--- ----------- 11 ---------" DATE ----------- ----- ----- - -------------- ----------- COMMIrNz`FV4 S r _. � n- � - - - --------��`�'----�.s�- A �----------------------------------------------- -- ------ -------- ----- �rE .4- �1 �' S�-----'"'�+�._._-.-`............. .............. ._------...._._----_-__------_... --------------.--.__._-----_-.r__-___ _ _.__..._ _ ..___ . .._... ---- ------------- -- - ................................... _.... _..._.._..__ _ .. .__.. .-._._ - .__ .______......_______--....----------......-----.---._... ------ _ _ _ � _ _ _ Final Insp ---------------------------- - Date ----------- JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M