70-177 - Laserfiche WebLink

Home Browse Search

x FOR OFF!XE USE: APPLICATION FOR SANITATION PERMIT Permit No.. .- d (eple�_in Triplicate) ------ ------------------ - `t � Date Issued -.�-_��__�d This Permit Expires 1 Year From 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: D _&K\FF 2 - n1a R S.c?c_ Sir N M' r``- CENSUS TRACT --5-1�--------------- one ---- -------- - JOB ADDRESS/L�� I ��- �,- Sta- '� = Owner's Name - ' '��--------- -- ---- -= ------------------------- -------Phone ---------�oti Address ACX c916-------�rer-}�-�� y-c- C��=. . City --------------------------------- Contractor's"Name ---- .------ ------.License # ------- ----------------- Phone .----------------------------- Installation will serve: Residence W.Apartment House❑ Commercial ❑Trailer Court l❑ } Motel ❑Other -------------- ---------------------------- Number of living units------ Number of bedrooms ----S------Garbage Grinder NP--- Lot Size --- -__ C _e--------------------------- Water Supply: Public System and name ------------------------------------------ -----------------------------------------------------------------Private Character of soil to a depth of 3 feet: Sand'❑ Sift fl. iC1ayF❑ Peat }❑ Sandy Loam ❑ Clay Loam Hardpan E] Adobe's'-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----- x------- _I......------------ Liquid Depth -----5---g p Capacity 16,.S4P�%-Type 14de-"Material 0�e ��rr-- No. Compartments -_ "---f.---=.--- q Distance to n arest: Well -160-'_A"-------------------Foundation 10------ ---------- Prop. Line --- - -- --- -------- ,---- �k LEACHING LINE [ ] No. of Lines -------- Length of each line.--- � �r�-- Total Length _-- -.- - -- n 'D' Box ---✓... Type Filter Materia4e?_�!!�__l-�---De/apth Filter Material ------ -=i--------------------------------- SuM�S Distance to nearest: Well _-0 t-____---- Foundation -3_.---.. -- Property Line `7- _--------------- ------ - _ �T [� / �1 _ -----__---- Rock Filled Yes No Depth - -------------- .Diameter x-- - -{Number - Water Table Depth ----- ------ ------------------ -------Rock Size --r - .- --------------- Distance to nearest: Well ___�� ----------------------------Foundation --- ----- Prop. Line ---- ------- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ---------.------------------------) Septic Tank (Specify Requirements) ------------------ --------------------------------:---------------------------- i Disposal Field (Specify Requirements) ------------ -- ---------------------------------------- ------------------------------- ------ ------------------------ ------------------------------------------------------------------- i (Draw existin aired ------ - ----- - - - - - - --- ------------------------------------------------------------ - g and required addition on reverse side) i 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. Home owner or licen- sed agents signature certifies the following: ; employ any person in such manner "I certify that in the performance of the work for which this permit is issued, I shall not as to becom subject to Workm it's Com ensation laws of California." Signed x- /E {' Owner Title (If other than owner) - FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -.- - 8 --------------- DATE ��--'� �� ------------ ---- - ---- -- ----- - ------------------------------------ BUILDING PERMIT ISSUED ----- - --- -- --------------- --------------- - -------- - -----DATE ------------------------ - ------------- rTS f 1ADDITIONAA EN - --------------------- -------------------------------------- ------------------- -------- - —�� -- -.�.-.. .Date -- -- ----- -- ----- ----- ---------------------------------------------------------------------------------- -- --- ----------- - Final Inspection by: - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M