68-888 - Laserfiche WebLink

Home Browse Search

1 FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT �� ------- ----------------------------------------- I rmit No. --- 16 (Complete in Triplicate) Pe --- ------------------------------------------------------ _----------------_----- This Permit Expires 1 Year From Date Issued Date Issued F 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 complia c� _ ith County Ordinance No. 549 and existing Rules ahid.Regulations: _f`q'4--_ P -- t t�__.� (1 N! 1 �1` ENSUS TRACT JOB ADDRESS/LOC N .__ __ _ ?' _--__I__ Owner's Name ------1, � _ d_j------ ir' A/- -/-,i---------Phone ------------------------------------ Address ��` Clt Y ----- ----- --- ---- Contractor's Name ___--__ _ �. __________ ___ _ L----c-c— ---- -__---___________.License # .Phone . . Installation will serve: Residence artment House❑ Commercial Trailer Court i❑ t.,. Motel ❑Other ------------------------------------------ Number of living units:------/-_ Number of bedrooms ____Garbo e Grindel/-6--l- Lot Size ----_______..-.. Water Supply: Publics stem and name ________________________________ ______________Private Character of soil to a depth of 3 feet: ' Sand'[] Silt❑ Clay Peat ❑ Sandy Loam -❑ Clay Loam ❑ Hardpan ❑ Adobe Fill Material -- if yes,type __-_______________________ (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 sewer is a -ailable within 200 feet,) ff��f \ PACKAGE TREATMENT { ] SEPTIC TANK, ize------- ,�' ----------------- Liquid Depth ____ ___Z _.. Y Capacity Type _ /lMateriai a. Compartments -- -- t , � � Distance to nearest: Well --- -------------------- Foundation __./____-- ------- Prop. Line __ ............ LEACHING LINE [ No. of Lines -----Z../---------- Length of each line-_ --/4/)P Total Length �-- ......... D' Box �-__ Type Filter Materia[ �`� ---4Depth Filter Material __ -- e------------.......... :.... Distant to nearest: Well _�- /_--_ ---- Foundation' __!'_�_ _.________ Property Line. __ca---------------- SEEPAGE ` --- ---._•__.:..__ SEEPAGE PIT [,,} Depth -_s ----------._ Diameter J�----------- Number _____ _�_______ Rock Filled Yes Z No i❑ Water Table Depth �_ �1/------------------- -------Rock Siie ,r� lZ, ---------------------- Distance ------------Distance to nearest: Wel! ----- ---------------------------Foundation ---- Prop. Line -- /........ REPAIR/ADDITION(Prev. Sanitation Permit r# -------- ----------------------------------- Date --------------------------.__...---) f ' Septic Tank (Specify Requirements) --- --------------------------- ---------------------------------------------------------------------- -------•---------------- Disposal Field (Specify Requirements) ---------- -------------------------------------------------------------------------------- --------------- -------------- -------------- --------------- ---------------------------:---------------------------------- -- --------------------------------------------------------------------------------------- (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 th erformance of the work for which this permit is issued, I shall not employ any person in such manner as to become s t orkm n' C ensation laws of California." Signed ----- ��m Owner �i �t� BY ----- -- -- - ---- --- --- t n ow - -- ---- •ZC_.__�------------------- Title �/t�` �-. I (If er than owner) - FOR DEPARTMENT USE ONLY . APPLICATION ACCEPTED BY ------------ --------- -Ry-Q"nt-------------------------------- ----------------------- DATE MP-5_1_41'C5•------------------- BUILDING PERMIT ISSUED ------ ------ ..-- - ---------------- DATE ------------- ----------------------------- ADDiTIONAI COMMENTS _____ __ _ ______ _________ ______ _ _ ------- ---=--------- --- ---- ---- ------- ----- - - - - -- -------- --- k ------------------------------ -------- ---- ----------------------------------- ------------- -------------------------------------------------------------- ------------------------------------------------------------------------- - ---- - ----------------- - - - -------------------- -- - Final Inspection by: - f ------------------------------------------- --------------------------- Date * �----~ ------- -- ------- SAN JOAQUIN LOCAL HEALTH DISTRICT s E. H. 9 1-'68 Rev. 5M. =