69-387 - Laserfiche WebLink

Home Browse Search

FOOFFyCE USE: APPLICATION FOR SANITATION PERMIT r � � � � �� - Permit No. - ---- -------- •- ---- -- ------- (Complete in Triplicate) ------------------------------- ---------------- ------ p Date Issued This Permit Expires { Year From Date tissued f Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein is described. This application is made in compliance with County Ordi.nance_No. 549 and existing-Rules and Regulations: -00 SUS TRACT JOS ADDRESS/LOCATION6fS -- Qr= �` �� Al-/��'`� -----------------------------------------•------- - Address --Phone4 __6 Owner's Name ----------- _. Cit __��_�_ _.__�r---�---�-L?,X --- -- - --------- ---------- --------- -• Y� � l - --------- --------------------------------------- � Contractor's Name _� �.._ 6,/. ------ -------- ----- = License # -1�7 ._" Phone �i��3'� Installation will serve: Residence [Apartment House[] Commercial ❑Trailer Court ❑ Motel ❑Other -------------------- -----------------•- Number of living units:..__I__---- Number of bedrooms ;�A-__-__Garbage Grinder .----------- Lot Size ------------------ - --- - ---- Private El Supply: Public System and name --------------------------------------s - Character of soil to a depth of 3 feet: Sand' Silt❑ Clay F-1Peat El Sandy Loam ❑ Clay Loam Hardpan ❑ Adobe ❑ Fill Material ------------- If yes,type ---------------------------- }� (PI'ot plan, showing size of lot, location of system in relation to wells, buildings, .etc. must be placed on reverse side.) . NEW INSTALLATION: (No septic flank or seepage pit permitted if public sewer is available within 200 feet,) Size-6-Y ------------ Liquid Depth _�--------------•---- PACKAGE TREATMENT [�5EPTIC TANK'[ ��---�--`�-j� ' Q L 19'k' WS Material&''GVW- F�-No. Compartments _Z-----------= Capacifiy �Q---�--- Type - -- ---- - r Distance to nearest: Well (----------------------Foundation ----1.0_'--------- Prop. Line =-------- ------ Length of each line----!50_11 -------- Total Length _srl'1�/�_.---------•-- LEACHING LINE [�- No. of Lines ----- ------ -- - • ! 'D' Box _ - -- Type Filter Material -__ OL l __Depth Filter Material ___�__ --- --------- •----- ".+� Distance to nearest: Well ____�`_O_-- Property----- --- Foundation ___ ___________ ________ Line. ----------- SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number --------- -- -- Rock Filled Yes [INo C Water Table Depth ------------------------------------------------Rock Size -------------------------------- Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line -------_------------ ---------------- - ) REPAIR/ADDITION(Prev. Sanitation Permit# ----------------- ,--------- Date --------•------------------------- ---- Septic Tank (Specify Requirements --------________.-.- ------------------------------------------------------- ---------- Disposal Field (Specify Requirements) ______________ - - ------------------------------------------ ------------------------- __ ----- --------- - f ---------------------------- ----------------------------------------- --------- --------------------------------------------------------------------------------------------------------- --- (Draw existing and required addition on reverse side) I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin f the San Joaquin Local Health District. Home owner or licen- County Ordinances, State Laws, and Rules and Regulations o sed agents signature certifies the following: or which this permit is issued, I shall not employ any person. in such manner "1 certify that in the performance of the work f as to become subject to Workman's mpensation laws of California." Owner Signed - ------------------- ------------ ---------- ----------------- Title e ----------------------- ------------ (If other than owner) FOR DEpAttTMEN7 175E ONLY ._.__DATE __ ------76------ ---------•--- APPLICATION ACCEPTED BY -------- -------------------------------------------------------------------------------- _. I BUILDING PERMIT ISSUED -- --- --------------- --------------- ------- -------------`----- ---------------------------------------- ADDITIONALCOMMENTS ------- --------------------------------------------------------- ---------------------- ---- ---------------------------------------------------- __:=________:_____: __________ _____-__:_----:____---__--____ __ _=_::--______ --- ___ __ ____ __ 5- --6 __::___::-__:_ _ - Date -------------------------------------------- Final -------------- Final Inspection b ------------------------------ , SAN JOAQUIN LOCAL HEALTH DISTRICT f E. H. 9 1-'68 Rev. 5M