74-169 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR.SANITATION 'PERMIT ~ - ----------- _ 1_r_C -(�" ^ Permit No. ---- -------- i 7 (Complete in Triplicate) ? ----------------------------------------- --------------- This Permif Expires 1 Year From Date Issued Dote Issued Application is hereby made to thel Son Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinon` `Nos-549:and existing. Rules and Regulations: JOB ADDRESS/LOCA TIOI i ' ��_iaj ..... .. l --------------------CENSUS TRACT ---------t---------_- Owner's Name ------------------ --- ------------------------:------Phone Adde --` rss --- - -- City i - ' Contractor's Name _-_-----i-Q.------- Q __-- --------------------------------------License # ----- Phone Installation will serve: Residencepartment House❑ Commercial []Trailer Court i❑ otel ❑i Other --------- ------------------------------- Number of living units:_._ ______ er of Wrooms Garbage Gr' der 2 -_ Lot Sizes� _�Y. ._____________.___. r Water Supply: Public System and ane ----- -_: r E �1--------------------------------(- -----------Pri,Jate❑- Character of'soil To a depth of 3.feet Sand•❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan [] Adobe Fill Material -.,.IV If yes, type ---------------------------- (Plot _________________________(Plot plan, showing size of lot, looc+ation of system in relation to wells, buildings, etc. must be pl4.aced on reverse side.) k.NEW INSTALLATION: (No septic tank`or seepage pit permitted !f public sewer is available within 200 feet,j PACKAGE TREATMENT SEPTIC TANK ____ I ----------- -- Liquid Depth ...._..._.. Ca"aei ` Type = Material __ 1 No. Compartments Dis� tan a to nearest: WeI�fILr_ _"""___ _:_ `Founc{ation � Prop. Line " pp R L&CHING LINE f�No. of Lines ___..__ ._ Len th, of each line__.-�_-,er------- Total Length _/� ------------------ 'D* �____ .__ -•---- / 1 'D' Bo21!%'__ Type Filter Material _ _ -----Depth Filter Material ./(&________________,............. lA 3 Distanc to nearest: Well __ _ a /j/J --- -- Foundation _J___----------=--- Property Line _.�.__.------------- SEEPAGE -----_. - -.SEEPAGE PIT' Depth Diameters f_____ Number ._-_±_ ---------------- Rock Filled Yes M---110 iL s Water Table Depth "_-__'_ �- --U 4Rock Siz1% _...___------ l > -J -----Foundation _--.--•--•-• Distance to nearest: Well.----_- -= ! - -__- � Prop. Line _-- - -- I REPAIR/ADDITION(Prev. Sanitation Permit# ________________________________________y_ Date ___________________.__--- -------- SepticTank (Specify Requirements) ----------------------------------------------------------------------------------- ----------------------------------------.-----------------•----------------------------- Disposal Field (Specify Requirements) --------------------------------------------- ---------------------- ------------------------------- = ---------------------------- --------------------------------------------------------- t = ------------------------------------------------------=--------------------------=-------------------- 1 (Draw existing and required addition on reverse side) I' I'hereby certit�t"t'. I have prepared this application and that the work will be done in accordance with San Joaquin County Orda innces;State Laws, and Rules and Regulations of the. San Joaquin Local Haalth 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' 'Compensation laws of California."1. t Signed 'F X. - , am .. BY — l - ------ ------------ few --------------- :--------------- Title --------- ------ --------- ------ (If oth an owner) FOR .DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _ - ` DATE .- __- --------- ----- BUILDING PERMIT ISSUED ---------------------------- _ _DATE ----- ------------------------- ----------- ADDITIONAL COMMENTS --------------I i ------------------------------- -- -- ------- ---- - - ------- ---- - Final inspection by: --- f -------------- --- ------------------Date ---- % = SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M