71-568 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ----- Permit No. {Complete in Triplicate) pate Issued __6__� � ------------------------------------------------------ This Permit Expires 1 Year From Date Issued ` Application is hereby mode 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. 519 and existing Rules and Regulations: JOB ADDRESS/LOCATION `- .------az- --- - -rte ---l --_ !-�16�� Yrv- --------- ----CENSUS TRACT ----------- --------- Owner's Name _IAC' L - G 1f`�------------------------------------- -- -------Phone ------------------------------------- Address 1 t _/6 --- ----r-------------------------- ;- Ci#YW � a r Q/-•------- Contractor's Name ...Iv1K&_A,) ------------------------'--•License # SS -7-: ------ Phone Installation will serve: Residence-4 , part ment-House,❑ Comte ercial ❑Trailer.Court. ;Q__ Motel ❑Other -------g-----------------------'------------- / Number of living units------------- Number off�bedrooms _t ------Garbage�i5 der ___-_.-___._ Lot Size ��+� / Z-' Water Supply: Public System and name __l,,�c__�_ ..---14) -------_------------------------------------------Private ❑ 1 Character of soil to a depth'of 3 feet: Sand'❑ Silt❑ Clay ❑' Peat❑ Sandy Loam ❑ Clay-Loom Hardpan ❑ Adobe Material --- -------- If yes,type ____________________------- (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,) PACKAGE TREATMENT [ ] SEPTIC TANK:[ ] Sip---M�''S__ ___67_--__-. '------_-_-- Liquid Depth ------5-------_-.----- Ca -------_------ Capacity/ --------- 7 e _ c- ---Mafer.ial No. Compartments ----- -_......-- p Y� Ty �=- � -- Distance to nearest: Wel ______________________Foundation ____A___________ Prop. Line _45----------- LEACHING LINE { ] No. of Lines ----.---_�--________ Length o ach line-------daf_6------------- Total Lenyth _,170._.......-_ '13" Box - Type Filter Material ____ _� - �r kDepth Filter Material _____/_ ----------- s- Distance to nearest: Well --- _a cs-------_ Foundation - /Cg__.________. Property Line ____________.____________ SEEPAGE PIT [ ] De}�th ------------------' Diameter ----____________ Number .-----------_______-----___ Rock Filled Yes 0 No .0 7�� Water Table Depth ---- --------------------------Rock Size -------------------------------- 1" Distance to nedrest. Well --{-------------------------------------Foundation -------------------- Prop. Line ---------------------- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date _____________________--.__.-------1 I Septic Tank (Specify_Requirements) - q' 'nom`,•- -, '� ------------- Disposal Field (Specify Requirements) ------------------1------------------------------- ------------------------------------------- ------------------------------------- ------------------------ -------------------------------------------=---------------------------------------------------------------_--------------------------------------------------------------------------------------------- (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 i as to become subled to Workman s Compensation laws of California." : Signed --- ------------- ---- ---- G. Owner BY ------------ - ---------------------= ------------ - ---------- ---------- ----------------- Title ----------- ----------------- ------------------------------------ (If other than owner) FOR DEPARTMENT U5 L APPLICATION ACCEPTED BY ---------------------------------------- ------- --------- ------ DATE __.. --------------------- BUILDING PERMIT ISSUED------ ----- ---- - --- --- QATE ADDITIONAL COMMENTS ------------------------------------------------------ ---------------------------------- ---- - ----- ------ ------------- ----------------------------------------------------=-------------------------------------------------------------------------------------------------------------•--------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------- --------------------- Final Inspection by- ----------- -------------------- ------Date ---------_01 -------------------- -- SAN JOAQUIN LOCAL HEALTH D RIOT G E. H. 9 1-'68 Rev. 5M �