69-935 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: � - Com Iete �A�IITATION PERMIT - -- �-- - - -•--- - ------ --- APPLICATION FOR_- Permit No: _-/�--t- ( p in Triplicate) p5 ---------------------------------------------------------- _________________ This Permit Expires 1 Year From Date Issued Date Issued 1/_`,P:-f 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 rwide in c mpliance with County Ordinance No. 549 and existing Rules and Regulations: S JOB ADDRESS/LOCATION .r .1 __ <__Q --- ---~4"Yo/_®N__ _-S _____________CENSUS TRACT _________.______________ Owner's Name - nPhone --g-423- ��.} . --••--- Address �a _1. � `5 Com'{- TF - CitY - Contractor's Name ____�__e ___ _ _ # ____ Phone __ '. c .... tl-_-- --- !C �i¢/Y --.-:__-- _ .License 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 Cha*ter,of.soil to a depth of 3.feet: SandI t❑ Clay p❑ Peat❑ Sandy Loam ❑ Clay Loam;❑ i Hardpan ❑ Adobe ❑ Fill Material _.---------- If yes, type ---------------------------- (Plot plan, showing'size•of lot, location of system in relation to well is, l ildings, etc. must be placed on reverse side.) NEW INSTALLATION: _ (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) \� Al! PACKAGE TREATMENT, [ j SEPTICTAN K'(.t- Size-11XfX__y - ---------- Liquid Depth ----- t capacity A� ---:__ Typ _e�4-s/____ Material�r�P8��_ No. Compartments _�_-. Distance to nearest. Well ____�__v______________________Foundation __./C�_--- ----__ Prop. Line __,___��_`______ y l _ A q, LEACHING LINE [ j No, of Lines .___�________--___ iLength, f each line_ _ _5-___�;__________ Total Length �-5- Z)____°-_______. ' 'D' Box .__E____.__ Type Filter MateriaAmIX.,�_�____Depth Filter Material ---------- ! ' 4 At < 4 Distance to nearest: Well ______ ------ Foundation -------- Property Line ,;SEEPAGE PIT [ ] Depth [] ---------------- -- Diameter --------------- Number v-------------------------- Rock Filled Yes No ' Water Table Depth ------- Rock Size ---------------------------- Distance ------------------ ------ ; [ Distance to nearest: Well ---.----------R_____.__.-'�°---- Foundation a endation------.-�-------------- ro Lina ------_-----}-��• REPAIR/ADDITIdid(Prev. Sanitation Permit# ,rSeptic Tank (Specify Requirements) ---------- --------------------------------------------------=- ` I ,;Disposal Field (Specify Requirements) ----------------------------------------------------------------------------------------------------------------------- - � y . 1--`------------------i-- ----------------- --------------------- -- -------------------------------------2- _ '�. - - — =- ' --- ---------------------------------- €x# -. w- .� (Draw existing and required addition'on reverse side) _ I hereby certify that I have prepared this application and that the work will-be Bene in_accordance wit_h San Joaquin County Ordinances, State Laws, and Rules and Regulations c f the Son Joaquin Local Health District. Hoene owner or licen- sed agents signature certifies the following: ) y "I certify that in the performance of the ork for which this p#rmit is issued, I shall not employ any person. in such manner F. asio b com subject to Workma Co ensati,on laws of,California." Signed ------------------- --- `:- - ------- Owner - ---------- ------------- - BY --Q ��- / � Title ` ( other than-own' J FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY f ------------------------------------------------------- DATE ------- BUILDING-,PERMIT ISSUED ----------------------------------- -------------------------------------------------------;--------------DATE ------ ------------------------------------ ADDITIONA'L COMMENTS ------------------------------------------ -------------------------------------------------------------------------------------------------------------------- .---'----------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------- - ------ Final inspection by �'d'•��C ---------------------------------------------------------------------Date j ��r�------ ----- SAN i SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M.