69-451 - Laserfiche WebLink

Home Browse Search

/FOIA OFFICE USE: / APPLICATION FOR SANITATION PERMIT � --- - • - - (Complete in Triplicate) Permit No. ----------------------------------------______,_------_ This Permit Expires 1 Year From Date Issued Date Issued c�� _. Application is herebymade to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in com iance with County Ordinance No. 5491and existing Rules and Regulations: � G JOB ADDRESS/LOCATI� -�Q----- ------ -- ----CENSUS TRACT -------- ----------- ----------------- 1, 4 Owner's Name -- --- - 0 ----.Phone r �_`"S1 i.-.- 4 Address ------------------- - ----- --- -- City - ------------------------------------------------- - ---- 07 Contractor's Name ------ ___ . #- �-@ ----------- � --- I-------.License # l44 Sl ----- Phone _ Installation will serve: Residence ❑Apartmerit-House F❑ Commercial ❑Trailer Court Motel ❑Other ----- -- Number of living units------------- Number of bedrooms -----------.Garbage Grinder ------------ Lot Size --_- ---- ---- ' _------Private Water Supply: Public System and name ---------------- --- •--- -------------------------------- -------------------•-------------------�•- ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam •❑ Clay Loam ❑ i Hardpan ❑ Adobe ❑ Fill Material ------------ If yes, type ------_---------------___- .r (Prot p.19ri;"showing size of loft, location,pf system in relation, to wells, buildings,tetc, must be placed on reverse side.) F x � � bk .,, f .. NEW INSTALLATION: (No septic tank 6 �. I seepage pit permitted if public sewer is available"within 200 feet,) it OF s PACKAGE TREATMENT [ ] SEPTIC TANK, I Si e-__----_--_�--X_-` --------------- Cquicf Depth --- ----------.._. _. I, Capacity �-C1Q_ _-- --_7ype� ---_- _'---�Mater.ial--- - No. Compartments .--. --------- r Distance to °nearest;lWelr _Y --: __--_--___--Foundation-_ � Prop. Line ----------------------- 04. y LEACHING LINE [ ] No. of Lines ----_---_*/_-' :_ _ _k Length of each line--------_`?_J------------ -Total Length ------ Q_____________ ` ! ----=TJe-;-Filter"Mate ria l -iq ----Depth Filters terial ---_/L�----- ------------------------- Distance to^nearest:(Well __- _45"O----------- Foundation __X0 Property Line."f SEEPAGE PIT [ ] Depth --- "'-' Diael .ter -------- Number ---- ----------- ` Filled Yeses No ❑ _Rock Size / `i Water Table Depth `1. 10 ---------- Distance to nearest: Well ________-_hr -----------------Foundation ----ld--------- Prop. Line ....--!_:--:----..--.- REPAIR/ADDITION(Prev. Sanitat]on Permit# ------------------------------------------- Date --------------------.-------------) Septic Tank (Specify Requirem6kfs) -------------------- j - - ------------- t { ,Disposal Field {Specify Req krements) _ .--- ! -- ``--------'---.- � [ - --------L---- -------------_-----_----------------------------�,----_--------- _ ------------------------- -- - + s I - _ " I l --' ----- - ----------------------------- --- --------------•-----------I-"------------------------------------------------------------------------- "' . (Draw existing and required addition on re�erse side) I hereby certify that I have prepared this application and that the work will,be_done_in,.accordante 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 ( as to become subject to Workman's Compensation laws of California." T---- -� Signed --------------------- - - Owner BY ` - Title . (Ifo than owner). 4I FOR DEPART NT USE ONLY APPLICATION ACCEPTED BY - _ _ ---. DATE BUILDING PERMIT ISSUED ---------- --- -- Y ---- ' ---- 'F. . -- ` ADDITIONAL COMMENTS --,--- --- --- - - z�- � . 4a�. .. r ) 1 --------------- ------------------------------ --------------------------" ---------------------------------------------------------------------------------- - - t ---------- ----------------------------- ---- - - Final Inspecfion by: -�W- ------------••----------------------------------------Date __ - - - - _ rSANYJOAQUIN-LOCAL_HEALTH,DISTRICT- E. H. 9 1-'68 Rev. 5M �~