69-815 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USS: -. APPLICATION FOR SANITATION PERMIT ' (Complete in Triplicate) Permit No: ---------------------------------------------- ------_----�------ This Permit Expires i Year From Date Issued Date Issued 41 . 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-.--- - - P � -------'5--------- --------------------------- ----.-CENSUS TRACT ------T 7_�q..--------- Owner's NameRQ_t / ------------=- =--------------Phone._ _� r1------- q ---------:5_UT-L!_F_F--------------------------- City ---i�,SC------------------------------------------------- ---------- Address ---1�-79 / ------CJ- �- Contractor's Name ------owfst�-K-'--------------- '-------------------------I------------License # ---------:-------------- Phone _ -. 1_ �... Installation will serve: Residence ®partment House❑ Commercial :❑Trailer Court [I Motel ❑Other '----------------------------------------- `. Number of living units:_---_!__=-,- Number of bedrro s _ _____Garbage Grinder/yAi_5 Lot Side __lam GNfD _G -------- Water Supply: Public System'dna;name ----------------------------------------------------------------------------- .i Private E] soil to a 8(pth�of3-feet:`and Silt[] Clay -❑ -Peat[f Sandy-Loam-❑ - day -- • Hardpan El Adobe ❑ Fill Material _ _/Jju/Q__'If yes,type ------------A______________ [Plot plan, showing size of lot, location of system in relation kta;w lit-bu'ildingfi;;ete. must be placed on reverse side.) V NEW INSTALLATION: (No septic tanVor seep a < '.pit permitted if public sewer is available within 200 feet767/ ) , ' PACKAGE TREATMENT [ ] SEPTIC TANK [ 'f Size_,?___LIQ---X_..7---------_-------- Liquid Depth -_6 _-�._------- CapacityType E TAB- Material_�0(.Gk-_' No. Compartments _---_--- �I Distance to,nedrest:,�Wel1 !Le hof each line______ -_{� J� Prop. Line____________ ____ _ - �� f -Total Length ---- �.. _ _Foundation ___ LEACHING LINE [ J-_--No...-of-Lin.Limes,________ ! g YP � { S , � - -- ion _:s��c-�-------- Pro er } Line ..--- -------------•--•- D' Box _ �S Type Filter Material __ Depth Filter .Material. ___'___ ____ ______ Distance to nearest. Well l ___________ _ Foundat _.. P tyl = SEEPAGE PIT [ 3 Depth ___� --------- Diameter _X- _: Numb. �--� �-=------ Rock Filled Yes �o i❑ Water Table Depth ----�----------------------- - -----------Rock Size --_ ____-- - Distance to nearest: Well .-----�� ------------------------Foundation ___`Y ------------"Prop. Line __ _--_______-__-__ g.. REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------- �---------- Date!---------------,'__-_------- -----) ' Septic Tank (Specify Requirements) -------------------------------------------= ------- -------------- `.: - - Disposal Field (Specify Requirements] - ------ k --------- ------- ------------- f ----------- 1 4 a: i _ = . _ - ,, . _- - ---- -- -------------------- --------------------------------- ;_ .(Draw existing and required addition on reverse side I hereby certify that I have prepared this application and that;the we `drk-will be.' one in dccordance::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: ) d< "I certiFy t i rhe performance of the work for which this permit is issued,_);shall not employ any p�ern in such manner as to be b'ect to ma ompensati.on laws of California."'` r t Signed ------------------- - Owner - T "- (If other than owner) FOR .DEPARTMENT USE ONLY s APPLICATION ACCEPTED BY - ---------------------------------------------------------------------------• DATE --- --'- ' 4 f BUILDING PERMIT ISSUED.... - -_."'-' = = - --:-._:-�.�_ =` = =_..-DA7E� ----------------------------------- --------------- --- �;=j= -�._: _ ADDITIONAL COMMENTS __ `-� `� - --- -----�F1 = LQ �1F_l `-( "�-Lkf .___________--____.________--_________ ------------------------------------------------------------ _.rte ____.________________a. _�- _------------------------------ -„'___ _ _ - .,- -,.e,..W - - �-.-_ __..mow....-...-- _ -- . ----------------- ____ _____ _________ ____ _ _____________________ _______ ______________-________-__________________________.___________-.__.____-_._____ ------------------____----------- _______ _ r___ ___ _ -_ _______ ----_ _ ____t_- .._____----______----_______------______-----_______-_--______. -.-__�-_-_(7- _C - - -- - Final inspecfion-by: j � - -------------------------- -.Date ----- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M