70-64 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE- APPLICATION FOR SANITATION PERMIrt ye�e}�r Perrrii:t No. �-r- kv l_ �4_---- � � 5- 70 - t o " A [Complete in Triplicate) Date issued _�."------------- ` --- A This Permit Ex fres l Year From Date issue i --- ---- - ---- ----- - -- a and in r A lication is hereby made to the San Joaquin Local it Cou tDistrict for permit and ex sting Rulestalnd Regulations- Application egulat onsl the work rem PP application is made in complian r described. This app ' %VW ---- -_---- Z_V�4nv -."----------- CENSUS TRACT __ ` I�Ph,one. --------- JOS ADDRESS/LOCATION _"-- ---- - 5 Owner s Name 57 --- - ` City -1 " `` •� II J- V- �-'" c1 r . Phone _yfc Address ---- ----------- - i ' Contractor's Name __.. -Q. ----- -- ------- -- - - - ------ --'-- -----'--.License # 1� --�- --�- -- ResidenceXApartment House❑ Commercial ❑Trailer Court' l❑ installation will serve:. , --- --- .` _ Motel ❑ Other - � Lot Size �J�" ----------•--- pp Garbage� r.inder .___------- Number of living units:__--_! ". Number of edroo =-- ---i Private ❑ 1 ------------------- j Water Supply: Public System and name,_L- .,4 Clay Loam:❑ ` Silt❑ Clay ❑ Peat❑ Sandy Loam,'[]. Y i Character of soil to a depth of 3 feet: Sand'❑ 9 - --- y Hardpan ❑ Adobe' Fill Material n- if yes,type " _------------------------- Hardpan -- buildings, etc. must be placed on reverse side.) (plot plan, showing size of lot, location of system i+ relation e�m ttedof public sewer is available within 200 feet,) NEW INSTALLATION: [No septic #a seepage p' p G P '� y' �( :_--- Liquid Depth _--- SEPTIC T �ize-- X-� PACKAGE TREATMENT [ 1 + 1 \ = Materialsyt�i�o* Compartments ------ PACKAGE ) �P YPE \ Capacity w -- ------- ---------- Distance ----- G �.- --------- Foundation Prop. Line Distance to nearest: Well ---�-' --- ,oy s - ,�" . Total Len ��-/-Q ----- ---------- LEACHING LINE No. of�Lines ---- ------- Length .of edch line-"-- --------- s Type Filter Material liG-j- -- . Pth Filter Material __/ ---------- Material Property Line. - -------•-------------- Distanc to nearest. Well '--------------- Number - ...._ _ _ Rock Filled Yes Na id - ' SEEPAGE PIT Depth { - Diameter i j� f Water Table Depth ------ - _ -------Rock Sizes --'-� i I . t . ------- on Prop Line � . _ Foun�a. _-.Distance-to-nearest:Well.==-.---_= _ - �- ti ------ Date ----------------------------------) REIPAIR/ADDITION(Prev.rSanitation Permit# -------- --- -- ---- ----- -------------°-----_ i - ---_-- ------------------------"-- i Septic Tank (specify Requirements) --------- Disposdl rField [Specify Requirements ------ -------------------------- ------------- Draw existing and required ad - ----- --- -- ------ ------- ---------------------------------------------------------- -- -- ----- ----- -.--- -- -- --- -- dition on reverse sidel,+ - t ( x.- I hereby certify that it have prepared this application and that the work will he done in auordance 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-- thiserson in such manner "I certify that in the performance of the work for-which permit is issued, i shall not employ any p as to become subject to Workman's Compensation laws of California." --------------- '. Owner Signed --- -- ----------------------------------- -- ---- --- t ------ - Title - ------------------ By k (If other'than own FOR .DEPARTMENT USE ONLY t6----------- _ DATE _��---.'�..'�• --- APPLICATION ACCEPTED BY __ Vii- -- ------ - - -------- ------------- BUILDING PERMIT ISSUED -____.------------ --- -- ----- - ---- - ---------------------------------------------------- ---"----------DATE ---- --- ---�------- -- ADDITIONAL COMMENTS ------------------ - _ ------------- j --- ----------- ------------------- I -------- ------------- ------ = ---- ---------------------- - -_ --- - - ------ � _ Date ------------- Final Inspection by: N JOAQUIN LOCAL HEALTHDISTRICTf E. H. 9 1-'68 Rev. 5M. s