70-578 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: 6 APPLICATION FOR SANITATION PERMIT -- Permit No. 70--- --� (Complete in Triplicate) __ This Permit Expires 1 Year From Date Issued 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. JOB ADDRESS/LOCATION .- - --+ -��?" -7-_ ---�_I +G` --f( ------------------------CENSUS TRACT --------------••-_------- Owner's Name ------- -- -tel • ;7` -- -- -- --- �j Phone- Address ----------- Ci#Y rC - ---------------------- ........... rr Contractor's Name --------- kZ J . ` _, License # / __ Phone Installation will serve: Residenc Apartment House❑ Commercial ❑Trailer Court I❑ Motel ❑ Other -------------------------------------------- Number of living units:------/---- Number of bedrooms ------3---Garbage Grinder ------------ Lot Size ____--------------------------------------- Water Supply: Public System and name -------------- --•--------------------------------------------------------------------------------------Private [� Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay loam ❑ a Hardpan Adobe'❑ Fill Material ------------ If yes,type -------------------------_-- (Plot pian, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) 1 NEW INSTALLATION: (No septic tank or seep ge pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ I SEPTIyyC TANK:[ Size-S-_-1C_ID_-__1(----�___-�.-..........Liquid Depth -if___�.. ......... Capacity - . 1 _C ____ YP __ 7 e _ _� __ Material_`�Li�_._..Q, _ No. Compartments _.-- - O . Distance to nearest: Well ------------SP-f-------------Foundation ---------/_`D.._`.._ Prop. Line -.__, -_f______ �1 ••LEACHING LINE [1�/ No. of Lines -___--__ ---------- Len g ! g th of each line-..__-.TOC? Total Length :----AZn�_-.-_-_-__ D' Box _.__ ___.___tType Filter Material ----- ILK'__Depth Filter Material .-_---�- --------------------l---- -------- �. Distance t nearest: Well _,______ 4_�_`--- Foundation ----------- Property Line -----!________________ SEEPAGE PIT [ Depth -._---t�s-----_ Diameter _.� �3___-- Number ------------- _--_--____ Rock Filled Yes No f� Water Table Depth I-� Rock Size --- _/_ ' x °3 t �0 t -Foundation 0 t--___------ Pro L -------- Distance fo nearest: Well.---_---i�-- -.�_ ______________________ p. Line ------ - -REPAIR'ADDITION(Prev. Sanitation Permit# ------------------------------------------ Date ------------ ------..--------------) f Septic Tank (Specify Requirements) --------------------------- ---------------------------------------------------------------------=------- -- --------------------------- g y-tDisposal Field (Specify Requirements) .----------- - ---- ------------------------------------------------- ------------------------------------------------------ t ---- ------- -------------------------------------------=-----" ---- --------------------------------------------------------------------------------------------------------------------------------. (Draw existing and required addition on reverse side) I 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: ( "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 Wor an's Compensation laws of California." Signed -4------------------------= ------ ------------- ---- *IMENT -------- Owner . BY k k Title (If other than owner) FOR DUSE ONLY APPLICATION ACCEPTED BY ---- - - - ----------------------------------------- --------------- DATE _ _` O-'-0------------------ BUILDING PERMIT ISSUED --------------------------------------------------------------------------- ---------- ---- --------------DATE -------------•----------------------------- ADDITIONALCOMMENTS ------------------------------------------------------------------•----_-----------•----------------------------------------------=--------------------------- ------------------------------------------------------------------------- ------------------------------------------------------------------------------------------- . _..� -------------------------(f-�---------- -------------------------- ------ --------------- ,- :------------------------------------------------------------------------------- ------------------------------------ : ------------ --------------- --------------------- ------------------ - --------------------------- ------------------------------------------ ------- k 1l ----- Final Inspection by: ------ ------------------=--------------------------------------------- - Date SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M e