70-402 - Laserfiche WebLink

Home Browse Search

0 1-7 APP IL Zo{�' C,_ , /6 FOR OFFICE USE: CATION FOR SANITATION PERMIT ------------------------------------ (Complete in Triplicate) Permit No. _ b -------------------------------------------------------- 5_ _________________________________________________________ This Permit Expires 1 Year From Date Issued Date Issued _(0--- -'-70 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: Lot 1G17 Laaolla and poplar; g J Rive acg JOB ADDRESS/LOCATION.-__- - ---- - - ---- --- - - fEr SUTRAT` -------------- ----------- 5-6 Owner's Name ----------JjDhn__,X21'tes----------------------------------------------------------------------- --- ---Phone ....8.3 Address J-0000 ----------Box---163Z.6a------------------------ city ----- Tracy------------------------------------------------------- Contractor's Name -P41M_qU!.S:4__P1Lilitbing__S"i/C_.--------------------------License # -995��` ---_-- Phone _635!!!3!Vt-----.-. Installation will serve: Residence Wpa rtment House,❑ Commercial ❑Trailer Court i❑ Motel ❑Other -------------------------------------------- Number of living units:______ Number of bedrooms -_1.......Garbage Grinder ------------ Lot Size _100r.x6 r---------------------- a Water Supply: Public System and name ---------Z_.j* R1v__ex-__Club-water--.SyStem--------------_--------.-Private ❑ Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam:ME Hardpan ❑ Adobe'❑ 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,) PACKAGE TREATMENT [ ] SEPTIC TANK [ ] Size------------------------------------------------ Liquid Depth -_-----_-.---.-..---.--- Capacity -------------------- Type -------------------- Material---------------------- No. Compartments ...................... Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line --_------------------ LEACHING --.----_- ------.LEACHING LINE '[ No. of Lines ---------------/------- Length of each line--__�d-------------- Total Length ---------_ - .jam. e-----.. 'D' Box ------------ Type Filter Materials �_,c14-...Depth Filter Material .E_�f_ Distance to nearest: Well _ _r------- Foundation _- b ______ Property Line __-------- ............ SEEPAGE PIT [ ] Depth ____________________ Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No I❑ WaterTable Depth ------------------------------------------------Rock Size -------------------------------- Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ---------------------------------_) Septic Tank (Specify Requirements) --------Xxi&tIgg----------------------------------------------- --------------------------------------------------------------- Disposal Field (Specify Requirements) ----5! _ lin 1't S 2t# a` WId@ leaabing drain - ------------ - - ------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------ ------------------- -------------------------------- ---------- ---------------------------------------------------------------------------------- -------- (Draw existing and required addition on reverse side) fl 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 performance of the work for which this permit is issued, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed PAIMQUIST PLUMBING S-. . BY - - - - - -- Title --------- x1�i$Qr -- - - - --------- ------------------ (If other than owner) FOR DEPARTMENT USE NLY APPLICATION ACCEPTED BY -------------------------------- =------- ------- 1 `----------- DATE --�� y- BUILDING PERMIT ISSUED ------------------------- ------- ------- �` - -------- DATE ------------------------------------------- ADDITIONAL COMMENTS ------------------------------------------ ---- ---- - ----------- ( ------------------------------------------------I---------------------------------------------- --------------------------------------------------------------------------------------------------------- ---------------------------------------- -------- - ---- ------------- ---- -- --------- ---------------------------------------------------------------------------------- -------------------------- ----------- ------------------------ --- -------- - - ------ - --------- ----------------------------------- --------------------------------------------------------- ------ Final Inspection b ----- -------------------------------Date ----- =/a" ----------------- JOA IN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M