69-959 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT C'� �J ----------------------------------- q-- 1=5 ! -------------------- 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 made in compliance with County Ordinance No. 549 and existing Rules and Regulations: ]Rgoad fan Soaquin JOB ADDRESS/LOCATION . 3000__ICaAP9t1_-R03d_.zpt-_-lpa -R_ -- Od--III'•------CENSUS TRACT --R-jagr-.01Ub Owner's Name --------MWP A---09-9 4 --- ---Phone ------------------------------------ Address -444__X...j5:th t,_rPe-@ - CitYa111d-----•------- Contractor's Name _______PAI,W-M,"-_PLI MHING__ _ ---:--------License 0-9-9-59-4- --------- Phone 835!!344--___,_ Installation will serve: Residence [ artment House'❑ Commercial ❑Trailer Court Motel ❑Other -------------------------------------------- Number of living units:-----31--- Number of bedrooms -----3L....Garbage Grinder . Lot Size _501; LQQt_ Water Supply: Public System and name - -COMMN= Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe'=Fill Material ___________ If yes,type __________________________ �1 (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 TANKa]a Size_ 2541t'-______________________ Liquid Depth .-48!!-------- Capacity ____1204_,.__ Type _-- -Q)9=- hllaterial_P2*-eaSt No. Compartments ------ .............. Distance to nearest: Well ----3_ -----------------------Foundation -------Wt_____-__ Prop. Line ......15t........ �0 LEACHING LINE jdr No. of Lines --------(Me-------- Length of each line_______8ot------------- Total Length -------$Q1--.--------.-- 'D' Box ------------ Type Filter Material _Sr.Q.I2t1q__1*th Filter Material ______----- -----------.............. Distance to nearest: Well ------3-001 Foundation -----101------------ Property Line ------------51k SEEPAGE PIT [ ] Depth ____________________ Diameter _______________ Number ---------------------------- Rock Filled Yes ❑ No WaterTable Depth ------------------------------------------------Rock Size ------------------ ------------- Distance to nearest: Well _______-__.____ -------------------- -------------------- Prop. Line ----____----_----._... REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date -________________________________) SepticTank (Specify Requirements) ---------------------------------------------------------------------------- ------- ---------------------.-----------•-----••--------- Disposal Field (Specify Requirements) ------------------------ r- r-_- [ ---- !------------------------------------------------ ---------------------------------------------------- ! ------------------------------ --------------------------- --------------------------------- (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application, and that the work will be Oone 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 becoPA MQUIST Wht1441 OdC4i elan: aws of California." Signed P. O. Box-254_ _ CINIM - -- - --------- g --- --760 East Grantline fIA� Title -----1�+Ial�►4ge�x_____ ._______- _ BY --------------------- (I f'o 'thl� 017 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------------------------------------------------------------------------- -------------. DATE ---------------- -------------------•- BUILDINGPERMIT ISSUED ---- ------------------------------------------------------------------------- ----------------------DATE ------------------------------------------- ADDITIONALCOMMENTS ---------------------------------------------------------------------------------- - --�----------------------------------- --------•- ------------ -------=----------------------------------------------------------------------------------------------- `� Final Inspection by: - -Date -0-=4 -° , SAN JOAQUIN CA HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M