70-161 - Laserfiche WebLink

Home Browse Search

FOR OFFICE use: ° APermit No. PPLICATIOWFOR`SANITATION PERMIT -� ` x4 4 D`.-------- Oto,•(Complete J Triplicate) �-�- ' Date Issued _ - tl ff This Permit Expires f 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 Gp my Ordinance No. 549 €nd existing Rules and Regulations: JOB ADDRESS/LOCATION __ FOP # 1 CENSUS TRACT __._______________..----- 3 r .- Owner's Name -------- ��w ---- Phoned e, CityAddressS = _ I --- ----------- -------- -- ------- - 1 �6a Contractor's Name ------------- 1. __------ " License #� ;S�------- Phone �t Installation will serve: Residence ❑ Apartment House❑ Commercial ❑Trailer Court i❑ Motel ❑Other -------- --------------------------- t h 7Q x I -----r`. a e Grinder -------• -- Lot Size -- - ------ -- ---- -- --------------- Numbe'r of living units:_____(_tNumber of bedrooms _ I __--Private Water Supply: Public System and name _________�_----------.: .__ _ `�--�--------- ---------------------- Peat ! Sand Loam [] Clay Loam '❑ Character of soil to a depth of 3 feet: Sand'❑ Sity❑ Clay❑ ❑ I Y ------ If a ---------------------------- Hardpan-C] Adobe Fill Material � qes,type 9 � �`#, '-a -✓ buildings,-lett. must be placed on reverse side.} (Plot plan, showing size of lo`t; load-tion-of system ,in relation to wells, NEW INSTALLATION: (No septic tank or seepage pit permittedif pu} [ c�sewer is available within 2QQ feet,I (�_t SEPTIC TANK' ) Size-----------------•-------- ------------- Liquid Depth ---------------------.---- "v PACKAGE TREATMENT { ] ,, d -� -- Material------ 11-1 No. Compartments ---------------------- t T e Q Capacity -_-- # YP � _ 'Foundotion�i ---- Prop. Line ---------------------- . Distance to nearest:,Well ___________________________,• ri-- tr zcR v.\, Total Length --------------------------•- LEACHING LINE [ ) No. of Lines -------------------------Lengthi bf h liner---------------- --- - g iDe th -Filter Material ------------------------------------- ox'p' B ------- .__. Type Filter Material. __- _.__ � p Dante to nearest: Well --------- ----- � - Foundation ------------------ Property Line -----------•-----.._... De Depth Diameter --_--____. t_- ------ Rock Filled Yes ❑. No ] 4 SEEPAGE PlT [ ] P l l 4 - Water Table lDepth ---------------------------------------- % ----Rock Size - ---------------------- _._ ... , F 'R __F�oundatio Prop. Line ----•---------•------- _ Distance to nearest: Well --------------------------�-- ---- - t i --- - Date I REPAIR/ADDITION(Prev. Sanitation Permit# -------- ----- ------ -- - - Septic Tank (Specify Requirements) ___ e Disposal Field (Specify Requireme- is} � 1 -----" -------- k ______________ __________ (Draw exist'1 , - -g ----- 41 �1 � __Q__ - ancl'required addition n re�erhe slide) I hereby certify that I have prep redt this application and'that the worOw� ill be done in accordance with San Joaquin County'Ordinances, State Laws, and Rules and Regulations of the Sanhoaquin Local Health District. Home owner or licen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued; I shalllnot employ any person in such manner as to become subject to Workman's Camp nsae tion laws of California. r {{ -------- - -------------------- . Signedl ------- - - i- Owner ' - Title - ---------------- ------------- i j (If oth y an owner) 1 5 FOR DEP A MENT USE ONLY - — DATE ....-3---� �2 APPLICATION ACCEPTED B �f- --T'-- - DATE ---------------------- -------------------- BUILDING PERMIT ISSUED __ ------------ ADDITIONAL COMMENTS ---- ----•------------- ----------------- ------ ------- ------------------------------ -cry.. ------------------------------------ ------ -- --- --- - Y----.-... -----.Date --- --- -------- ......------------Z---------------- - Final Inspection b --------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'b8 Rev. 5M