70-269 - Laserfiche WebLink

Home Browse Search

I FOR OFFICE USE:, ' APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. _7�_=02�_ ---- / ____.__._.______--------------- 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 - ---------- ------------------- -------------_----CENSUS TRACT -----------------•-------- Owner's Name -.0 &----- 0.0 Grp_e,A------------------- -- -------------------Phone ------- - - ----------------- ,, ---------------------- Address �} --------- ------ City -_"4.0¢`` ------------------------\ . Contractor's Name ........ __ pp '----------------------------------License # �Zlione'! *_'---- ............ e Installation will serve: RosidenceA Apartment House❑ Commercial ❑TrailerCourt l❑ . .Motel ❑ Other -------------------------------------------- Number of living units:__ ._._-Namb2r"af`bedroorrfs _ Garb"gam"GTHnder"/ _A!otSize'^ 42 r Water Supply: Public System and name --------------------------------------- --------------- ------------------------------------------------- .._PrivatL-ZR 1 V Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay Q P,eatbSandy Loam Clay Loam ,E],. ,,,Hardpan ❑ Adobe'❑ Fill Material ----- M1If yes, type ------ --------------------- {Plot plan, showing size of lot,,location of system in relation to wells, buildin ,s etc. must be placed on reverse side.) pr NEW INSTALLATION: {No septic tank r seepage pit permitted/if" pudic sewer is available within 200 feet), l, PACKAGE TREATMENT 'SEPTlCT K' Size � � Material��__ .�.�____ No. Com artment��_—��----- � �__°�_- �-��_ Li uid De th• -f i .Z-.------ P w YPf o P $J I Distance to nearest: Well __ _�'__________________Foundation XVV--_--___---___ Prop. Line 4------------ ........ ii i LEACHING LINE No, of Lines _ --------- R Total Length------ Lengt4 of each lir / _ g r �.................... 'D' Box ;Type Filter Mate iaf�� PJ04V6&pth Filter Material __ �_-.;.........:.......... i F Distance to neares". Well�� --_--__-____-__ Foundation Ao-- ----------- Property Line .01 __._._.._- 5 ti3` SEEPAGE PIT Depth -_--- I.Didmeter _ ,��= Number ._�`�__--------------------- Rock-Filled, Yes,4 No`i❑ / �1 ® ` ---------------- D / Water Table Depth'-.--�r-----------------------------------Rocfk Size,- --------------- �pt t � � � - Distance to'nearest: Well __�Q_a___ _ _____--Foundation `�_®_ _.___ Prop. Line ` .. . � REPAIR/ADDITION(Prey. Sanitb`tionn_Permit# __-___.`_______________3_______.__.__.---- D#ate ________________""-_____ _---- ' pp��i Septic Tank (SpecifyLRequirements) A`=`` #k;'4-'--------------------------------- ---=-- -----------�- -------------------� Disposal Field {Specif )ReqI irements --------- ------------------------------ -__ - -----_-___-- t= " r= I I hereby certify that i have prepared this application and that the------------------------------------ --- - -------------------------------------- ------------_- ----- 1 (Draw existing and required addition on reverse side) r e work will be done in accordance: with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local HealtliDistrict: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's Compe satio�la'ws of California." ' s Signed - = Owner BY ---- --------------------- ------ Title ------ ./� E_.. ----------- -- ill r t an owner) # . FOR DEPARTMENT USE ONLY I APPLICATION ACCEPTED BY --. ------------------------------------------------------- ---- DATE 2 V y----------- BUlLDING PERMIT ISSUED - -----------------------"-----------'------------------------------------------------------=--------------DATE -- -------------------- --------------- ADDITIONALCOMMENTS ------------------------------------ --------- --------------------------------------------------------------------------------=-- ------ --- t --� .i t% f -------------------------------------------------------------------- - ------ ------------------------------------------------- ------------------------------------------------------------ -- -------- - ------------------------------- - 1 E - - - - - - - - - -------------- --- - - Final Inspection by: Y'�'� . - -------------------------------- ------Date _/ `"" lS- ------------ SAN JOAQUIN LOCAL HEALTH DISTRICT .— E. H. 9 1 '68 Rev. 5M a i s, I% .,