68-1060 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: r APPLICATION FOR SANITATION PERMIT -------------------------- Permit No: --64 -�D�- ,. (Complete in Triplicate) ------ - ---------------' Date Issued - _-��-`�.� - -----------------------_t-------+--------_-------_-_--- ti. This Permit Expires 1 Year From Date Issued f c��-36 Application is hereby made to the San Joaquin Local Health District for a permit to const ucf and install the work herein dessc�ribed.'This application is made in compliance with Coynty Ordinance No. 549 and existing Rules'and Regulations. 3 C ..• 'l- r r. Jam, ' ` ------ R�1 --CENSUS TRACT ------6----JOB ADDRESS/t0 ATION .-_ _.�__GR�s-.-------'� TF� � -_------- Owners Name' - - _ � ty ..... -------Phone ----- ------ Addressi �_-_ 7�f .� t= Q� l= =1� --_�^^^_---�- .... �—- -------------------------------- --- --------- - Contractor'rs Nam. _C01VG.RE46� 7T VP11`-------------------------------------------License # =---- - ----------------- Phohe --------------•--------------- Installationiwill-serve: Residence ❑Apartment House-E] Commercial :❑Trailer Court ❑ I V Motel 2Ether _7HURGH-------------------- Number -- -------------Number of living units:- ----- Number of bedrooms-- ------Garbage Grinder __ :---- Lot Size --- ©_x /_Z_0------------- L1 �. ' Water Supply: Public System and fia ------ -R_T lRQ .....G1_T_>b_ )LRT. R---- �11c ----------Private ❑ t Character of soil to a depth of 3 feet L'Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam �Iay�Locim,,E] --...�� ,,�. .....,- Hardpdn❑ Adobe'❑ �` ' yes;typ t rhiatsr al--= -_-If e_-- (Plot plan, showing size of lot, location of system in relation to we�S, buildings, etc. must be plaeWd on reverse side.) I tyi � E NEW INSTALLATION: (No septic tank or seepage pit permitted if pubic sewer is available within 200"feet,) PACKAGE TREATMENT [ l SEPTIC TANK'[ l Size------------------------------------------------ Liquid Depth -----------------•---.----- W Capacity ----- ---- --------- Type -------------------- Material---------------------- No. Compartments ----------------------- Distance to nearest: Well ------------------------------------Foundation ------------------- Prop. Line,.._- ------------------ Gh LEACHING LINEA [ ] No. of Lines ----------- ------ Length of each line---------------------------- Total Length --------------------- { 'D' Box ------------ Type Filter Material --_----------------Depth Filter Material ____I---_- __-..-------.--__-- _ Distance to nearest: Well -.-,:-------------------- Foundation ------------------------ Property Line- --------.-----_.-_._._-- SEEPAGE PIT, [.] Depth- -------------------- Diameter ---------------- Number ---------------------------- R ckF Filled Yes ❑ No 0 ova Rock Size ------------- E +� Water Table Depth ----------------------------------- ----------- -------�f��-----�- Distance to nearest: Well ----------------------------------------Foundation ----------.-----�-i_- Prop. Lute ...................... _f REPAIR/ADD11110N(Prev. Sanitation Permit# -------------------------------------------- Date __-_----_-_-_-__--------I r Se tic Tank 1S ecif Re uirements ----�., -- - :---------- x � -------------- t Disposal FjVid (Specify Requirements) 1/V$7W�------�EASF------ M-0A>---=---- } -�lRr�h f 5 ------- -------- ? L�AC.EF----- 4 : `T .I'Y ----------a-�vx-------PRA► - Ro_ '[�S :A_ 1- `z"F11 UA ---el T- - SEInIEZl` J�1 R� 'T�- -- ----- -- - -- - "�-�'*� - (Draw ex sting and required addition an reverse side}' I hereby certify that I have prepared this application and that the work will be donein accordance with San Joaquin �County-Ord inances, State Laws, and Rules and Regvlegtjgqs oftAhe San Joaquin Local HelalI District. Home owner or licen- sed agents'signature certifies the following: - � ,a J_H t-U 4_4� "I certify that in,the performance lof the work for which this permit is issued, I shall not employ any person in such manner as to be" sub'ect to f m s p ation laws f Cali��nia." i Sig � ------------i----�--=�t .----------- Title ----------------------------------------- BY - = (Iffiother than owner) 1 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----------Z a R-'0-------------------------------------- ----------- --------- DATE ----- � ---------- BUILDING PERMIT ISSUED ------ ---------- DATE --T � _ -- ADDI`fIONAL COMMENTS .-------- ------------------------------------------ 44 a I t ..l.__ Final fns ect-nr--b- - -- -- ---- - --- - - ----- - ----------------- --- -- --" - ------------------------------------ - ----------------------------------- -Date ---- .�-l- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M �,