68-629 - Laserfiche WebLink

Home Browse Search

`FOR OFFICE USE: f ` A KATION FOR SANITATION PERMIT -- ---- ------- - • � "=t'•, :,,�. (Complete in Triplicate) Permit No: ______________________ Tkis Permit Expires 1 Year From Date Issued "- 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 County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION/``S� V-410 ;'1V4A�,aNSUS TRACT -------------------------_- Owner's Name y�l. ------------------- ��---------------- -- '�!. - ---- -- - - - -- - -------------------- ----- ---Phone ---------------------•-------------- Address -- ---------- Address /'1�+ / A,S' 6,r �----------------------------•--. City _ i1�I�/ 1 �'---------------------------------------------- Contractor's Name .__.__ - - PLO-.-Xonle ------------------------------------------ - License #1,W13F 9!9� ._ Phone16 "__;z1v Inst � ti n will serve: Residence$Apartment House❑ Commercial❑Trailer Court ;❑ Motel ❑ Other -------------- ---------------------------- N tuber of living units:-----/___ Number of bedrooms AY______Garbage Grinder IVL9-- Lot Size _ 00,0'WO---------------- ater Supply: Public System and name ---------------------------------------------------------------------------------------------------------------Private Character of soil to a depth of 3 feet: Sand'❑ Silt.0 Clay [-] Peat El Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe Fill Material ------------ If yes,type ---------------------------- Y (Plot plan, showing size of lot, location of system in relation to wells, 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,) &3 PACKAGE TREATMENT f ] �SEPTICTANK Size. --r> l_________________ Liquid Depth -- I/ / N , • ;-------------•-- h c ti � Capacity,_ - --- Type Material_ r Na. Compartments ----!�------------- �1 Distance tot nearest:-Well ----_-----------------Foundation ------------ Prop. Line -t _---________R , i ' �3 LEACHING LINE No. of Line3._-z__A_.__-_____---- Length of each line_____9e4._________-_-__ Total Len th �_�"�_.8_ ____-_--_ 'D' Box �.S__ Typelf1ter Material 114of -X_Depth Filter Material _ ��______._____________________ Distance 10-nearesf:=Well•- --------------- Foundation _ rl_ ___________ Property Line ....... SEEPAGE PIT Depth ____01 0 tDiameter J-3------ Number ......V,- ------------ Rock Filled Yes X No Water Table Depth -----------------------------------------------Rock Size --------------- �.. I/ r Distance to nearest:"Well _-AQ---------------------•-_Foundation Prop. Line ---A.1f.29........ z REPAIR/ADDITION(Prev. Sanitation Permit# -------------- Date ----------------------------------) Septic Tank (Specify Requirements) •-- -- --------------------------------------------------------------- ---------------------•-------- ------------------- DisposalField (Specify Requirements) -------------------•--------•--•--------------------------------------------------------------------- -------------- ------ h ------- -----------------------------.------------------------------------ ------------------------ ------------ ----------------------- � ------------------------------------------------------` ----------------------------- (Draw existing and required addition on reverse side) 1 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. Nome owner or licen- sed agents signature certifies the following: ; J certify that in the performance'of the work for which this permit is issued, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of Califbrnia." ' Signed ---------- ------ -- Owner s -------------------------------- BY ------------ Title --- ----------- ------------------ (if -- ---- - - - --------------------------- er than owner) F ''qq FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY `11 - DATE .... ._( _1 _ .. BUILDING PERMIT ISSUED ------- ------------------------------DATE ------------ --- --- --------- ----- ADDITIONAL COMMENTS - - ----------------- -- -------------------------------------------------------------------------------------------------------------------------- ---------------- ---------------------------------------- -- ------ -----r ----------------- ------------------------------------------- ------------------------------------------------------- -- - -- ---- ---- -V--------------------------------------------------- ------------------------------ Final Inspection by: --------------------.�-`--- ----- - 0__\ -----------------------------------------------------------------------Date SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev.45M I