70-688 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION POR SANITATION PERMIT a q.. 3 0 Permit No.�a-��- --- ------------- ---------------------- ---- �;�.. (Complete in Triplicate) --------------------- ---------- Date Issued ------- This Permit Expires 1 Year From Date Issued - Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION --------- _ --------- -.-----CENSUS TRACT ----------------•--------- ------------------ ---- �� ------------- -------------------Phone �„5---•---- Owner's Name ------------ /------W--�---,// �------- --- Address - 1--� 1 .+! 1[�t- G ------ City ==- ----- �, ( // q tl Contractor's Name -------- License #lW��/- Phone t712-7.T4 _T�----- ° ------------------------ si- k.? Installation will serve: Residersce 1AFarfr6661'House 1❑Commercial'[Trailer Court ;C 1 Motel ❑ Other ----------------------------------- -------- Number of living units: ---- _----- I Iber of bedrooms t___._ ___Garbage Grinder Lot Size ..____ _ Water Supply: Public System and name ---------------- '�•_ - ------------------- u- (- --- ---------------(--------Private ❑ ! I Character of soil to a depth of 3 feet: Sand'D Silt� --Clay, ❑ Peat❑ Sandy Loam ❑ Clay Loam :0 F Hardpan ❑ Adobet Fill Material ------------ If yes,type ------------- -------------- s (Plot plan, showing size of of lot, �loiation of�system in relati�n to wells, buildings, etc. must be piaied on reverse side.) {�� NEW INSTALLATION: V(No septic tank or seepage pit permitted if#p'ublic sewer is available within 200 feet,) "� 1 1 6N ! K' t ado t Size Liquid Depth -------------------------- PACKAGE TREATMENT [ ) _ ) F---____ i SEPTIC TANK' _ � - -- r pti _ •Material---------------------- No. Com artments ---------- ----------- ype----------------- TYPeM; , i p Distance to nearest Well -----'``- ----------------------^• undation __-- ----------------- Prop. Line --------.-------•----- LEACHING LINE [ ) No. of Lines ----------I------------- •Length .of each line--------------------- ------ Total Length _____.___.__..-----_____-- 'D' Box --- -------- TYPe Filter Material--------------------Depth Filter Material -------- ----------------------------------- Distance lo nearest: Well ------------------------ Foundation ------------------------ Propert4 Line. ------------------------ SEEPAGE PIT [ } Depth -- - ----_- -- Diameter --------t------- Number ------ Rock Filed Yes C] No 0Water Table Dep"tEi -------------------------------------------Rock Size ----------------------�------- - Distance to nearest: Well ----------------------------------------Found'ation N-r_-- -_---- -- Prop. Line ---------------------- - _ 1 REPAIR/ADDITION(Prev. Sanitation Permi/# -_€----------------------------------------- Date ---: ---------_-- 1 ----•-•--------------------------- Septic Tank (Specify Requireme#ts, .- -------I----.---------------------------------------- , B Disposal Field (Specify Requirements)----_.. ___, --•----fa I- ---- ------------ ---� -------------------------------- ----------------------- ;-� . ------------------------- I -- -------------------------- ----_-, � F (Draw existingand required addition on reverse side) Y certify ` I hereb that I have prepared this application and that the work will be done in a cordo ce 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: t "I certify that in the performance`of the work for which this permit is issued, I s all not employ any person in such manner as to become subject to Workman's Compensafion3owsof-,California.," .....-,,,—4 !f Signed --------------------------- ------- -------------------------------------- Owner -------- -- t . Title `---------------------- (lf of er t owner) F DEPARTMENT USE ONLY I j y DATDATE ACCEPTED BY =___..,� .-__- -_ .-� =---• ��- --r==�•�ry�"-�---�'r-�'-""' -z` BUILDING PERMIT ISSUED -------- --- ---=------------------ - -------- _ E ADDITIONAL COMMENTS -- ! V C.. : ». � - ---- - -•-- -- -- ---------------- ------------------------------ ---- ' ------ ---•------------------------------------------------------------- - ---------- ----- ----------.Date ..... -- ---- Final Inspection by: �-1----"------ --�----_ S ! JOAQUIN LOCAL HEALTH DISTRICT ice'✓ E. H. 9 1-'68 Rev. 5M ,