70-386 - Laserfiche WebLink

Home Browse Search

I FOR OFFICE USE: II --- 'PLICATION FOR SANITATION PERMIT I Permit No. -7s1_-3,RL ------------------------------------------ -------------------------------�i (Complete in Triplicate) R -------- 11---------------------------------- -;----- Date Issued r ------------------------------- -------------------------- This Permit Expires I Year From Date Issued il 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. 2 1 .' 6011y DTVB -------------CENSUS TRACT --•------ JOB ADDRESS/LOCATION I _ ._ ______9--- - -- Owner's Name --------------------------------------------------------Mrs- $Onnie ''rye . ------------- -------------------Phone $35-- rsQ2 ---- Address -- I)ae -------------------------------------------- City _.T? fig------------------------- ---------------------------------- 35 3_ ' Contractor's Name ----$a�'Lll.3�Sv'�---p�1mb.�.t]g--��''T'�7.0$------'--------License # ----9-`�5 ------- Phone -- - --- ------ installation will serve: Residence X]Apartment House-❑ Commercial ❑Trailet Court ❑ Motel ❑ Other ---------------------------------- 5at X-1:'5,, Number of living units:--- l�- ___ Number of bedrooms ____ arbage Grinder ----_______ Lot Size ----------------------------------------•-•- y em and name ________--_- Peat Sand Loam ----------- -----------Private 37: Water Supply: Pu is st Character of soil to a depth p h of 3 feet: Sand❑ Salt❑ Clay ❑ ❑ y ❑ Clay Loam- Hardpan ❑ Adobe-❑ Fill Material ------------ If yes,type 1___________________________ r (Plot plan, showing size ii'of lot, location of system in relation to welIs,ibuildings, .etc. must,be. placed mon reverse side.) NEW INSTALLATION: `'(No-septic tank or seepage pit permitted if public sewer is available within 200 feet,) f . -� Liquid Depth ------ PACKAGE TREATMENT� 0 SEPTIC TANKT r _--_--------------------------- s ___----- ........ ,/ Material TYp_ _ ,____Ca Capacity -- ------- istance to nearest: Well -------------- -------------------Founda#ion m:----------------- Prop. Line -------------_------ ---_ Total Len ---------------------------- LEACHING LINE: ; [ ] No. of Lines ------------------------ Length�of each line--.._______-------.- Length II s , D' Box ------------ Type Filter Material-----_---'----------Depth Filter MaterialL----------------------------------'----- D -------------------------- Foundation ; ----------- Property'Line t Distance to nearest: Well _ � , SEEPAGE PIT [ ] Depth -------------------- Diameter ________________ Number ---------------------------- Rock Filled Yes E] No Water Table Depthi-----.----Rock Size t-------------------------------- ii , Distance to nearest: Well ----------------------------- ---------Foundation ---------------- --- Prop. Line _..---------- --_--. V 4 REPAIR/ADDITION[Prev. Sanitation Permit# ------------------------------------- "'Date -__-"__________.�'---------------) p Requirements) ---- - - - -------------------------------------------------------•------: „<.------------------' Se tic Tank (Specify I ----- -- ---- - - -- - Disposal Field (Specify Requirements) -----100 .--g__2±_--wide-_leack�xng---d a.xn_R _�__ uRR�.6�u� t�� Tfrainag I= -------- ------------ -------=--------------`-------- � ------- ------ ---- ------ --- ---------- -------- --------- -------- i li ,... ------------- ----------- I--------- 4 E Ii (Draw existing and required addition on reverse side) I i 1 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'-perfbrma o t -wo as to become subject to Wor man's Co enrk for whieh'this permit is issued, I shall not employ any person in such manner i s n of lifor ia." # SignedP Z 'IQUIST-t P----- -----ING __S CI - ------- - --- -- BY - -------------------------------- - --------- -- ---------- --- itle ......Matlg_ T_ (If other than own IL FOR DEPAit ENT USE;ONLY i �O_ APPLICATION ACCEPTED BY -------------- 1 _ DATE "" `---------------------- BUILDING PERMIT ISSUED ------------------------------------ - - ----- -- ----------------DATE ----------------------------------------- ADDITIONALCOMMENTS -- ----------------------------------=------------------------------------------------------------------------- ------------------------------------------ ------------------------------------------------ - - --------------------------------------- ------------------ ------------------------------------------- ---------------------------------------- -------------- II: r Q�3� ` Final Inspection b -- --------- ---------- -- 1_ ----.Date _.-------------------- ------------ -- SAN JOAQUIN LOCAL HEALTH D1 RICT E. H. 9 1-'68 Rev. 5M