69-1059 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION 'FOR SANITATION PERMIT ------------------------------------•--------------------- (Complete in Triplicate) Permit No. / 1 Date Issued -------------- ----=---------------------------- This Permit Expires 1 Year From Date Issued ' l the work herein Application is hereby made to the So Joaquin Local Health t District a No. 549 and ex srmit to ting Rulesand talnd Regulations- described. Th' lication is made n co plic�r�cewith Co my /f. . �.� - �---• - - vlc, CA y+-i� -CENSUS TRACT ----J---------- ---- JOB ADDRESS/LOCATION -° �� -`- ---- � j r F Phone ------------------------------------ Owner's Name --------------------- -- ----- -- ------ x.0- 1---- Address --------c:.,9 �A7"�-----------`s' ------•------ ' �� :,I;,C�Yf �: J-t �..�s- f�_N_ 5. `.License13_ Phone "" ON2 Contractor's Name _-Tx ''t # ,� Installation will serve: 4Residence E] Apartment House'0 Commercial❑Trailer Court :E] Motel ❑:Other �ONl-- , - 3--/ ------- ------of living units:- --.--- Numberfof"bedrooms __ ...Gar 7e Gr.inder� -"- -- Lot Size --""-----�---- c I Water Supply: Public System and'name ---._ _ " _ - " - CI y Lo Private Character of soil-to a depth of-3-feet.—Sand-E] Sift❑ Gay-❑ -:-Peat-Ell Sandy.Loam-g� a� am-❑---- �--- ,. - Hardpan ❑ Adobe ❑ Fill Material ------ If yes,type --------- --------------- (Plot plan, showing size of lot, location of system in relation to'.weils, buildings, etc. must be placed on reverse side.) p seepage pit permitted if public sewer is available within 200 feet,)1 4- rr NEW INSTALLATION- {No septic tank or !� � (�s`� . Liquid Depth -----e_ -------.-----�® PACKAGE TREATMENT [ ] SEPTIC TANK'[ ] Size--,9a--/ `X -7. q P Capacity 1a` - -----: TypeC�S� Material�f ' �i --- No. Compartments --Z—=-----=---- 1 r-� Distance to nearest: Well ,. - ----------'----•-- -----Foundation f0---------------- Prop. Line ------ ........ LINE [ ] No. of lines ----- -------------- Length xf each line------60-------;------- Total Length ---/s,4_O""...-------- / � BC - --- Depth Filter Material ----- ��-------------------- 'D' Box _._".__"--_- Type Filter Materia -" - P � Distance to nearest: Well ----5�------------ Foundation -- ------------10 Property Line. -------- --•----- SEEPAGE PIT Depth -- Diameter ---------------- Number "_-- --- ------- ' --------- Rock filid Yes 0 No 0 Water Table DepthRock Size ---=-------------- --•----•---- --------------------------------------- I Foundation ------------------- prop. Line ---•---------•-------- Distance to nearest: Well -------------------•--------•- I -Date ------------------ 1 REPAIR/ADDITION(Prev. Sanitation Permit ----------------- Z . . } Septic Tank (Specify Requirements) --------- ----------------------------------------------------------------------- ----------------------------- Disposal Field {Specify Requirements} -.--_----_.-_------------------------ ----------------------------- e cc/ S'',�_ -t ------------------------------ -------------------- - ------------------------------- - ---------------------------------------------------- -__r �.. __ . � ---------------------- � . T . -----------------=-- -------- - ` (Draw existing and required addition on reverse side) r I hereby certify that I have prepared this application and that the work will be dbne in accordance with San Joaquin i, County Ordinances, State Laws, and Rules and Regulations of the San Joaquin LocalHealthDistrict. Home owner or licen- sed agents signature certifies the following: # "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner as to bepme su�b`jee t to Work n's Co pensafio7l laws o California." ! `f✓' �� -- -------•- Owner Signed ^n , 5l1 - - -------- ------- --------------------------- (/J- Title ----- By ; - -- - - - {!f other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - I ` ------------------ ----------------------------------------------- -----------. DATE ---- ------------- BUILDING PERMIT ISSUED --------------------------------------------------------- --------------------------- -- ---------------DATE -------------------------/---------- ---- - - - ADDITIONAL COMMENTS --------------------------------------------------------------------------------------------------------------------------------------------------------------------- . -------------------- ------------- =x= ----------- --- ------------- ------------ ------------------------------------ "� �:: ---------- ---------- - ------- - - -- --'---------Date --/--- --- - -'" Final lnspectio�y: .-.�� -�«-�----- - - �' ► SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M.