73-151 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT - --- ----------- -- ------------ - Permit No. /- (Complete in Triplicate) - ------------- ----- ------ --------------------------------------------------------- This Permit Expires 1 Year From Date Issued- r''7 i' ` .�V0)60 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: QLD _ -_ _. p JOB ADDRESS/LOCATION�I-T_��-:�___�-i1�'��='�_--=-. --------- TRACT __.�t ------ Owner's Name ---`--/q_C-if- ` = - R-� ---%- ---- _�_N.DSZ----------------- ---------------------Phone ------------------------------------ Address 1 I ------�-----R1xc - 1~ � .__. City ��` Contractor's Name ' Cir ` � �-i 1-.License # Phone Instal latian-wili serve:---- Residence,❑-Apartment-House,]-Co mmercial.:❑Trailer.Ge��#.; ---�- �Motel E] Other -------------------------------------------- Numlaer of-living-units:-_--( -Number-of-bedrooms.,-_-Garbage-Grinder :�= Lot•Size--.ACK ff_�G --...____ Water Supply. Public System and name \'•----------------------------•-------------------------------------- ----------------------•-•---•-----Private Character of soil to a depth of 3 feet: Sand-'ff Silt[] Clay ❑ Peat❑ Sandy Loam -❑ Clay Loam;❑ Hardpdn' ❑ Adobe ❑ Fill Material _-A'--o__if yes, type ____________________ _ _ _ �� i (Plot plan, showing size of lot, location lof•system in relation to wells, buildings, etc. must be placed on reverse side.) .--. %J.\ NEW INSTALLATION: (No septic tank or seepag p,it permitted'i "`tlbfie`sewer-is-sewerwithin 200 feet,) W /� `A ( ] ~� Size ; Liquid Depth ---- ------------- �PACKAGE TREATMENT SEP7lCTANK �' � �'C��X �`� � q p Capacity/%4.0 --- Type PA.a*-W57, Material_C0 --- ---TNo. Compartments ___�z to nearest: Well _____ __"�"_________Foundatio'--/a- =__ Prop. Line ___�____-f`�.. LEACHING LINE /Distance No. of Lines ------�____----------- Length of each line - -_ -_.______ Total Len _______ Length -��-------••---- 'D' Box TF�5 Type Filter Material _ _ __Depth Filter Material ____/ _/ f_________________________ i SEir i � MroS stanceM6cN to n arest: Well ______________________ Foundation ------------------------ Property Line,..___--_=________._.... SEEPAGE PIT [ ] Depth -------------------- Diameter _______________ Number --------------------- ------ Rock FilledINYes ❑ No 0 y Water Table Depth ------------------------------------------------Rock Size ------------------------ ,'•A-- � T Distance to nearest: Well ________________________________________Foundation ----------------------; Prop. Line 4---1................ f , REPAIR/ADDITION(Prev. Sanitation Permit# ---------------------------------_---------- Date ----------------------------------- Septic --__________Septic Tank (Specify Requirements) S------- Disposal Field (Specify Requi ements) ___ lVZEX----. 1��4?----T � ----moi rip ----��r`R - -- A/ n y � ' iAe /� ------- -lV `--------------�--:c_1V_ _�--------- �/t ��--------- jf----- '=------------------------------------------------------------------------------------------------=--=--------------------`T r c` ------- k "'f))raw existing and required addition on reverse side) 1 I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaq in County Ordinances, State Laws, and`lules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: "I certify in th perfor a ce of the work f hick this permit is issued, I shall not employ any person in such manner as to be sub) t to r an's Compe lifornia." Sign d = = ---------------.Owner BY - -------------------------------------------------------------- ----------------/ Q Title --------- ------------------------------------------------------------- (If other than owner) FOR -DEPARTMENT USE. ONLY APPLICATION ACCEPTED BY -------�t-?�10---------- ---— ------------------------- DATE 3- .z7_-��------- BUILDING'PERMIT ISSUED _:----'"_'_.-- ------------- -- - - ---- -��------=----------DATE ADDITIONAL CCiM-MENTS-.._.J...,,.--�•-.- --------------------------------- -- ----------------------------------------------1 > ------------------------- -------------------------------------- ---- ---------- } = = --------------------- -------------------------------- 3 t - -,.:fir` -------------=---------------------- ----------- - ---------------------- = --- ------------------ -------- ---- --------------- __ ---- - ------------------ --------- -- --------- Final Inspectio "_ - ' ----Date ----- ... ------ SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M