68-432 - Laserfiche WebLink

Home Browse Search

FOOFFICE USE: APPLICATION FOR SANITATION PERMIT 5 Vis'11W� 9 �� ------ ------- ---- '- Permit No-. i (Complete in Triplicate) - --------�- - ------------- - d -- '- Date Issued -------------------------------------------------------- This Permit Expires 1 Year From Date Iasugp Application is hereby made to the San Joaquin"Local Health District for ❑ 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: �JL JOB ADDRESS/LOCATION -�7 �-- --,-.._�Fl�'��-----�f�- aS- - -- -------------- -- ----CENSUS TRACT ------- ----------------- Owner's Name r=-��J = - = r Phone s -�ll� Address ------ --//--.I--�------&0 f_ � ------A/azye------------------------- City J - ----r--------------------------- Contractor's Name --- Q� --"- --------------------------------License #� - -0?_7.42,Phone�aJ7=.eZZ_-4_ Installation will serve: Residence%Apartment House,❑ Commercial ❑Trailer Court ;❑ IMotel ❑ Other ------------------=------------------- Number of living units:---- _-__i Number of bedrooms ________Garbage Grinder Lot Size _/Q(,?___.X __ __t ` -------- Water Supply: Public System and name ----------------~ =_-- ------------------------------------------ ------Private Character of soil to a depth of 3 feet: - Sand'❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam ;❑ Hardpan ❑ Adobe% Fill Material -A10- If yes,type ---------------------------- (Plot _______________________(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 sevYer is available within 200 feet,) f PACKAGE TREATMENT f ] SEPTIC TANK, Size__&-X--4-_t�__9_______________ Liquid Depth _�jl/ TYpe Caaci dee, fs/— Material_O—fAoej-,P//e-No. Compartments a7- P Distance to nearest: Well ____ 7cl---_-------------------Foundation ---/0------------ Prop. Line ---30------------ LEACHING LINE Jif No. of Lines -----oZ-------------- Length of each line----;x4-_-_----------- Total Length '1,l-4--iQ.............. 'D' Box i �G_ Type Filter Material�� ®_Depth Filter Material -1 _ _______.................. _____ Distance to nearest: Well ___ Q�-____�_ Foundation ._,f,�__'________ Property Line. __ Z_Q_____________ r�d ?�9_ �- SEEPAGE PIT Y' Depth 4�_pJ __ _ Diameter 9-S--____ Number _.____.0 ----------------- Rock Filled Yes ( No C] L Water Table Depth ----- ---- --•-.- ---- ---Rock Size d----Zig-____-- f Distance to nearest: Well ___ �Q_______________________Foundation 1_0_4'r____ Prop. Line 2_0------__-__-- � REPAIR/ADDITION(Prev. Sanitation Permit# -•------ ---------------------------------- Date ----------------------------------} f i Septic Tank (Specify Requirements) -------- ---- -- -----------------------------------------------------«---------------------------- Disposal Field (Specify Requirements) -------------------------- __________________________________________________.____-___-___-_________--_-______..______-___________________________-_____-___-_______-____-__-_-____-___________________-_____.____-___________________ f [ (Draw existing and required addition on reverse side) ,.. I hereby certify that I have prepared this application and that the.work will be done is accordance�,with�Son "Joaquin County Ordinances, State Laws, and Rules and Regulations of the. San Joaquin Local Health District. Glome owner or licen- sed agents signature certifies thefollowing: "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." Signed ------------------------------------- Owner , BY ---------?. (if ---- f ------ ----------------------------- Title =---------------------------------- oth r than owner) I FOR DEPARTMENT USE ONLY. ; APPLICATION ACCEPTED BY - - -- - -------------- DATE ------- BUILDING PERMIT ISSUED _- � 50 _ a`-- - --• - - -- ---------- ---- ---- �--_(: TE ------------•----_--------- ADDITIONAL COMMENTS .s --- -- ---- --- ---------------- `f�� a- - - -�--- - p -r----------------------------------------------------------------------------------------------------------------- ----------- ---------- -- --------------------------------------_rte -- - i w ------------ --- - ---- ----- -- - --- -- -------- --------------- al Inspection y: � ------------ -- -----.D ------ ------- ----- ------- - - ---------------------------------------- -- Fin NAQ LOCAL HEALTH DISTRICT I E. H. 9 1-'613 Rev- 5M