69-146 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE` APPLICATION POR SANITATION PERMIT --------------------------- -------------------------- Permit No. _6-T7112�6_._ (Complete in Triplicate) Date Issued _,....-...This.Permit Expires-y.-Year From Date Issued - _ -.- -.—�-.-,.•- -_. w —- - 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 Count Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION . -`-------------...-.--,CENSUS TRACT i Owner's Name ----------- tl I -----"�,�f _ ------------------Phone..�I�� -' � jC -.---- "'Z 3 >- = 'i= = 1 ' 1 - ----i- City i ------ Address _________________ + Contractor's Name ----OW.1_i��`------------------------------- --------------- - ------.License # ---------:-------------- Phone --- Installation will serve: Residence ❑ Apartment Hou3e, Commercial ❑Trailer.Cturt f�` Motel ❑Other --------------,'-------------------------- Number of living units: ____�____ Number of bedrooms "`__Garbage Grinder __Lot Size 1� a+ 'Water Supply: Public System and name ----------------------------- -----•.---------------------------------------------------- ----------------- -- -•Private Character of soil to a depth of 3 feet: Sand' Silt �C{ay ❑_ Peat❑ Sandy Loam [] Clay Loam it -------- ------------- (Plot -- -- -- -- Hardpan [] -Addbe [ �, Fikl^Maternal Q �If yes,-type . . (Phot plan, showing size of lot, location of system--in.-relation:._to(w.ells,.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,) r PACKAGE TREATMENT { ]. SEPTIC TANK' �u ., FRSize-. .�__, ....... Liquid Depth t— _.--- ., �„-r : c carte+C rt + Capaclt .._. xdQ TYpe- I Material No. Compartments _: « i W Distance'fo''nearest Well ' `=�' __�__ ?__...._.-Foundation 10.____+-.----- Prop. Line --- 1 00 LEACHING-LINE-•-�j'�No, of Lines_a;N---- _______________ •Length go .e8ch line____.__._._-___-n_----.-_ Total Length --------- ------ it _-._f/ --- - -- -- F 'D'-Boz _ Type Filter-Mater = _____Depth Filter Material -------- _Q----------------- -- ------- r .r ' ' .-� Distance to nearest. Wel l ._.5-�•---.....= `'� Foundation _�Q.._. '-_-- Property Line ................:. r d { SEEPAGE PIT [ ] Depth .................... Diameter ------------� -.'Nomber ----------------.----------- Rock Filled Yes ❑ No 1❑ Watier Table Depth 1 ----- ------- ' c Sze ---- Barest: Well __ Ro ) Distance•ton _.._ = 1 Foundation ----- j- Prap. ine t................. �.-_ . _. 1_.. .. 1 h REPAIR/ADDIT[014.,(Prev. Sanitation Permit,# .._..._ - ------------------------------ Date _----- ------------} Septic Tank (Specify Requirements) -------- ------------- ----- -- ,; ------------------------:---------------- --------------------------- - --------------------------- - e4 iDisposal Field (Specify Requirements) ------------------------------ ----------------------------------------------------------------------------- ---------- ----------- ------------------------------ ----------- --------------------------------------------------------------------------------------------------- ----------------------------- -------------------------- - - k (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 County Ordinances,'State Laws, and Rules and Regulations of the San Joaquin 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 shall not employ any person in such manner to �-�� of California." • �1"-j :-,� "...,� j. ' Signed ned eco� ubject to Workman' Comp s��n�ws� •�Y g Owner i BY --- ---------- ----- -------------------- ------ ------------------------- -----------------------. Title --------------------------------- - ------------- ------------------- (if other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY i.I `0' ------- ---------- '- DATE /----------- BUILDING PERMIT ISSUED -------------------------- -------------------------------------- --- ------- -DATE ------------------------------------------- ADDITIONALCOMMENTS --------------- - ----- --- - ------------------- ---------- -------------- ------ ----------------- -------_.. ----------------- -------------------------------------------- --------------------------------------- ------.--- - --------------------- ------ -- --- - ------------------- --------------------------------------------------------------------------- - -- -- ---------- - r . -------- - Final Inspe --------- -------.Date SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M.