69-622 - Laserfiche WebLink

Home Browse Search

w FOR OFFICE USE: -APPLICATION FOR SANITATION PERMIT / ------- ------------------=----------------------------- Permit No; - -�- -=------------------------------------------------- {Complete in Triplicate) Date Issued ---- This Permit Expires 1 Year From Date Issued F Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein described. This application is made in compliance with County Ordinance No- 549 and existing Rules and Regulations: E kr,71? s - Ha--)L� �a S1 JOB ADDRESS/LOC ION ------ -------- -- ---------------CENSUS TRACT �t� t Phone Owner's N e -04 _ - - _ - -- '��- I Address City - ---------------- - _ Contractor's Name ___ __-License #A� ��ed „ Phone ------------------------------ Installation will serve: Residence ❑Apartment House❑ Commercial Xrailer Court 'Q y tMotel ❑Other ------------------------------------------ Number of,living units------------- Number of bedrooms ------------Garbage Grinder ----------- Lot Sze ------------ Water Supply: Public System and name ------------------------------------ -------------------------------------------------------------------------Private Character of soil to a depth of 3 fee' Sand'E] Silt❑ Clay .Q Peat❑ Sandy Loam Q Clay Loam..F HardpanX Adobe'Q 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 available within 200 feet,) i S_X_�. • PACKAGE TREATMENT { ] SEPTIC TANK` Size__3X------ f-------------------------- Liquid Depth ------._-_._-_---.••------ ' apacity � ( Material__ ---- No. Compartments ter• � i r +� -----Foundation ",� --. --_---.Prop. Line -S_-__.� f►_-- Distance to nearest: Well _��--___"�_-----_-_- LEACHING LINE ( No. of Lines -------r-------------- Length of each line-------3Q--t-_- -_- Total Length -_-_"g ..--------- w� i 'D' Box ---_ --_.__ Type Filter Material F;pClS ,Depth Filter Material ____I- -------------• •- ------------- -+ h Property Line. ..:.t- = j Distance to nearest: Well -lQ�-------------- Foundation -- •' K lea 5 SEEPAGE PIT ePt - --- = ; c ___a------- ----- - ------- Dist c re --- - ------- - --- ----- -- ---------- REPAIR/ADDITION(Prev. Sanitation Perm' --- ----------------------------------- Dat -------_-__-_-------------------- ) --- 1 Septic Tank (Specify Requiremenfis) -- �' 1 f/ ----.------------ ------ Disposal Field (Specify Requirements)- � - ---------------------------- ----- ------------------ ----------- ------------------------ ----------------------------------------------------- s ` ---- - ---- -- ------- ---------------------------------------------------------------= f- ------- -------- ------- ------- ----------- _ r y {Draw existing and required addition on reverse side)— "` ` A. 1'hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin i County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Healthlbistrict. Home owner or licen- sed agents signature certifies the following: --�- f "I certify th in the performance of t ork for which this permit is issued,'I'sholl not employ any person in such manner as to be subje to_WorkrTA4's pensation law o alifornia." / Signed Ow --------------- e I - -- ;------------------------------ ---- (If other than own -- - -- �-FOR DEPARTMENT USE ONLY ACCEPTED BY _ � � Of-&Si� ----------------y-----. DATE ------ APPLICATION BUILDING PERMIT ISSUED ------------------------------- --------- ---DATE i ADDITIONAL, COMMhNTS---.-- -------------------- ----- ------ ------------------------------- - ------------RAW �^I 40CAT-01------[�------LFA --�Ni E------- � ;: '` Final Inspection b ------Date---.;.----� r`---`------- SAN JOAQUIN LOCAL HEALTH DISTRICT �t E. H. 9 1-'68 Rev. 5M.