69-979 - Laserfiche WebLink

Metadata

Thumbnails

Annotations

V FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT �-- (Complete in Triplicate) � aw- Permit No. ---- -------•-•- -- This Permit Expires i Year From bate 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 rrlqdespliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ---- ---- -- - -------------CENSUS TRACT ----------- Owner's Name 9 --------------------------------------------------Phone ---------------- -•-------...------- Address �/ - p -/� fs1------------------------------------ - City �4 - Contractor's Name __-._ __ ^— �� rt�--= �- -------------------- License--license # - - . •2_��Phone Installation will serve: ResidenceApartment House'❑ Commercial ❑Trailer Court '•❑ « Morel ❑Other --------- = Number of living units:------ Number of bedrooms __ _ __ Garbage Grinder --— ------ Lot Size Water Supply: Public System and name - f EP,�(Y4---4:.fS-/_a-Ze-,T-------------------------------------------Priv ate ❑ Character of soil to a depth of 3 feet: Sand'E] Silt❑ Clay ❑ Peat❑ Sandy Loom ❑ Clay Loam ,[] t Hardpan ❑ Adobe Fill 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 Size lfj�,,7 - y1'- ------------------- Liquid Depth r . ---------------- I5 Capacity140'P----- Type o0le -- Material_�'�Sbf --"- No. Compartments -2----------------- Distance to nearest: Well ------------------------------------Foundation ------- Prop. Line ---- LEACHING LINE No. of Lines ______�--__________ Length of each line_____3.0. -- . Total Length 'D' Box . _�' �� Type Filter Material /if/e,&Depth Filter Material _f�'S`-- Distance to nearest: Well _______ _____________ Foundation _2.4---_------ Property Line ----6:�.... _ _....___ SEEPAGE PIT Depth De �I p ----- - Diameter r7,,�___ Number _.�--------------------- Rock Filled Yes No 0 , Water Table Depth ------ --- --- ----------------------------Rock Size Distance to nearest:.Well ----------------------------------------Foundation .s3f ._______-- Prop. Line _ �_ ----•-•-__--- REPAIR/ADDITION(Prev. Sanitation'Permit# ------------- ------------------------------- Date ----------------------------------) Septic Tank (Specify Requirements) Disposal Field (Specify Requirements) ------------------------------------------------------------ --------- ---------------------- - l L ------------ --- ------------------------------------------------------------------------------------------ - - -------------------------------------------- (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 4:as to become subject to Workman's Compensation laws of California." Signed ------------------------------ __ Owner BY / - - - {-�leo?7 Title --- E w ----------- 1 (if other than owner)`-;! FOR DEPARTMENT USE ONL I/7 APPLICATION ACCEPTED BY ----------------- -. DATE --/- ___-,.7 ----"_---- BUILDING PERMIT ISSUED - --- -------- -------------- --------------------- ---- DATE - -- ------------------- ADDITIONAL COMMENTS ---------------i -------- ---------- - -- -------------------------------- --------------------------- -------------------------------- - t� ------------ ------------------------ ----------------------------------------- Final Inspection by: _. ------.Date _ ------ . SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M `