69-491 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: TM APPLICATION FOR SANITATION PERMIT � Permit No: (Complete in Triplicate) .--_. --'- --------------------------------------------------------- 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 mad in compliance with County Ordinance No. 549 and existing Rules and 'Regulations: JOB ADDRESS/LOCATION .---'`# _ _ --A5`T----QA5uUN-C-_7000---------------------------------CENSUS TR T _----',-:-?-------------_ Owner's Name ----- �-kO---C8 y AE ------------------------------------- ---------------------- Address - - �?.��------ Address ----6-g_-_!aAt4 A------MPKQa-A---tt�A_ � .. .. Cit-- �TtjCIC.TDI)---------------------------- -- Contractor's Name bA-t_'_-N1 T'r-SW1 GE_ lsposAL-_�-,_ .License # - - II Phone 4(------384---1_---__-_ � Installation will serve: Resijence`AApartment House[ Commercial ❑Traller Court ❑ � Motel ❑Other----------- - ------------------------ Water i Number of living units:------I-__- Number Cof bedrooms-- --- r--------Garbage l Grinder 0D------ Lot Size S ----------------------- Water SuPPIy. Public System and name --- -\ -+d ❑ Character of soil to a depth of 3 feet: Sdhd C❑ Silt❑ Clay E] Peat❑ Sandy Loam ❑ Clay Loam❑ 5 -�dpan ❑—Adobe Fill Material ----- If yes, type ---------------------------- (Plot plun—, showing size of lot, location of system in.,relation to wells, buildings, etc. must be placed on reverse side.) NEWI INSTALLATION- O septic tank or seepage pit'permitted if public sewer is available within 200 feet,) PACKAGE TREAY-AAENT [ SEPTIC TANK'[ ] Size---------- --------•--------------------__------ Liquid Depth ------------------------_ WA. `C• Capacity -----)----------•-- Type ----------•--------- Material---------------------- No. Compartments ---------------------- Distance --------------- ---- w Distance to Larest: Well ----------- __Foundation ---------------------- Prop. Line ----------- .......... INo--tff-L'in'es ------------------------ Length of each line---------------------------- Total Length -------------.._._..__------ LEACHI 6-NNE [ ] + D' Box - ------e Filter Materiel ----____----___.--_Depth Filter Material ------_--.-__--_--_.- -- ....:.... Distance to nearest.-Well E-----------J--------- Foundation ------------------------ Property Line ------------ ........... -- SEEPA'( [ ] Depth Diameter ____ ___________ Number - -------------------------- Rock Filled Yes ❑ No ❑ , ------------------- Wate[ T#blk..,'Depth ............... ------Rock Size -------------------------------- Distance to nearest: Well -- ----------- -- -----'_.____'______Foundation -_-__----.--------- Prop. Line ---------------------- 4, RE6'IR/ADDITION(Prey. Sanitation Permit# ----------------___-_ ------- Date -------:_--_-__-_----__--_--_- eptic Tank (Specify Requirements) Disposal Field (Specify Requirements] -__� �1pe �l_ Db-1T7-D __--QF-3Z-__LtNL -ET" i A -- --- -- k w 1 ---------- t_------- - -- ------ ---------------- -------------- ( -- (Draw ex�stin -and-re wired addition on reverse side) r.� I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin - County Ordinances, State Laws, and Rules cind Regulations of the. San Joaquin Local Health District. Home owner or licen- sed-agents signature certifie the following: ' L31'r. "i certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner uJih bs'stolbecorine subject`to Workman's Compen�ati.on laws of California.: { hg�s!9Red ------------ Owner Y --- ---------------------------- ------ ------- ----------- -Title __ ap_-._ �(if other' than owner) "h ! ,. FOR ,DEPARTMENT USE ONLY =t APPl11CATION tACCEP,TED BY ----- i DATE _-G 13UfLDING PERMIT ISSUED - 1------------ --------F----I-------- -----------------------------------DATE --------- ADDITIO L COMA { t--------- - --- ----- - - - --- ---------------------------------- f _c---------------------`--'--- ---- - R al;lnspectiori,by: # ----- --- -------- } _ -------------Date _ f ------------ --- ---- - ---- _ - -- -... --� _. � . -.. SAJ.OAQU.I.NJQCAL_HEALTE._DIST.RI.CT—�� E. H. 9 1-'68 RIT5M')