69-80 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: � � , fid APPLICATION FOR SANITATION PERMIT �? �-�---- --� -- '------ -- --- - (Complete in TPermit No. �__9_Q____ .� riplicate} __ ___________________----- This Permit Expires 1 Year From Date Issued Date Issued a?-_C7 . .67 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 . ' ' ---�-----�-------------------------------- CENSUS TRACT ----------- - Owner's Name ---- J�-r �L Phone Address --------- --- -----•��' � 1� �1�-6___ P Y - %<''-----------------------•-------- ------- Contractor's Name -------_e�G �1---=- Pa/ ------------------ - - Phone � f -- - -------------License #�C�- .-- - �-� Installation will serve: Residence ❑ Apartment House❑ Commercial ❑Trailer Court i❑ 517w "glad' .,.. ...,Motel ❑Other""w"`=--="---- -------�` ----=-------`v"_ g y J ms __ ___-Garbage Grinder —_____ Lot Size _ __ _ �- .. ................... Number of living units____ ____ Number of bedrooms � � Water Supply, Publics stem and name ----- !_- ------- F�� ---.�v'f 11:E:- --------------------------------------------Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam Hardpan ❑ Adobe -$ Fill Material N®---- 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,] V PACKAGE TREATMENT [ I SEPTIC TANKb4 Size__ . __$� _! _ f------------------ Liquid Depth __ __/ U1 I Capacity _9_19()--------- Type /"e'lale - Material_r ;e, -No. Compartments _.1�7___ Distance to nearest: Well ------------------------------------Foundation _ -------- Prop. Line -•..----------- f LEACHING LINE [A No. of Lines _____ _________________ Length of each line____lf_�_______________ Total Length ,___ C •.__..____._.____ 'D' Box p Type Filter Material lyFl .Depth Filter Material _- �______._---_•_____••___._.____ Distance to nearest: Well -____________ Foundation ___. -- _________•Property Line- __-47-_____________ SEEPAGE PIT [ ] Depth ____________________ Diameter ---------------- Number ---------------------------- 'Filled Filled Yes ❑ No .C] Water Table Depth ------------------------------------------------Rock Size --------------------------------- s Distance to nearest: Well ----------------------------------------Foundation ------ ___----------- 'Prop. Line -.---------._:-------- ir REPAIR/ADDITION(Prev. Sanitation Permit# -•------------------------------------------ Date ------------------- ------------ r 1 SepticTank (Specify Requirements) ---- --- ------------------------------------------------------------------------------ j= -------- ---------------•-- Disposal Feld (Specify Requirements) ----------------------------------------------------------------- ------------------------ h - - ---------------------- -------------- ----------`-- --------------------------------------------------------------------------------l------- ------ -------!-------------- I---I------------------ ---------------------- --------------------------------- -- --------------------------------------------------------------------------------- ------- ----------------- --------- ------------------ (Draw existing and required addition on reverse sid I hereby certify that I have prepared this application and that the work will be doile-in accordance withSan 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 no� employ any person iifsu ch manner as to become Wbiect to Workman's Compensation laws of California." ti Signed Owner ----------- -- ----- - ` � BY ! ---- --- � -------------------- Title G - (If other n owner} FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED B - --------------------------------------------------------------- DATE __a'-/� BUILDING PERMIT ISSUED --------- - ----------------------------------------------------------------------------- - DATE ADDITIONAJOMMENTS ---------------------------------------------------------� ----•-----•--------------------------------------------- -------------- --------------------------- ------- -- -------------------------------- ------------------------------------------------------------------- --------------------------------------------------------------------------- ----------- k`---------- ----------- ---------------------------------------------------------------------------------------------------------------------------------------- - --- - .. -- - ---------------------- - - Date _ Final Inspection by: -- -------- -------- -- Z"1 7 -,,C%. � 1 SAN JO_AQUIN LOCA_ HEALTH _DISTRICT E. H. 9 1-'68 Rev. 5M