69-343 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION" FOR SANITATION' PERMI. Permit No. - - ------------ (Complete in Triplicate) e -------------------------- Permit Expires 1 Year From Date issued Date Issued This, p Application is hereby made to3the 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: .7S a CENSUS TRACT --------------•------- JOB ADDRESS/LO TION ._-1------`�-- - --;. - -- -------- = --==------------ Owner's Name __`Tn -- ---- - -------- M-•. ------- -- ----- e ---------------------- 5 ----•----•---- I ----- - Com'_ _ Address ------------------------- ---------------- = ty.� " Contractor's Name ------ ---- ---I license # ." 'J P ne Installation will serve: Residence Apartment House-0 Commercial ❑Trailer Court ',❑ Motel E] Other -- - --------- --- - - - Number of living units:___--- Number of bedrooms -14_____Garbage Grinder _--___._.__- Lot Size -- ----- ---- -- -_--"-__---_Private Water Supply: Public System and name -------------------------------------------------- -------------------------------------------- I ------------------------------------------ E IPeat❑ Sand LoamClay Loam :❑ Character of soil to a depth of 3 feet; Sand'❑ Silt❑ Clay ❑ Y _ Hardpan 0 Adobe E] Fill Material ------------ If yes, type ------------------- (Plot plan, showing size of lot, location of system in relation to wells, buiildiirig-s, 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 --------------------------- I Compartments ---------------------- V Capacity --- ---------------- Type --------------------- Material------------------- No. FoundationProp. Line ----------=--=-- Distance to nearest: Well --------------------'-- of Total Length ---------------------- ------ LEACHING L1NE%A ] No. of Lines ------------------------ Length., each line---------------------- � IMF _ -------------- --De Depth Filter Material -------------------------------------•------ � , -___--___-_ al :5� Property Line- ----- ------- -•-------- Distance,to nearest: Well __---�__-_-"___-____ Foundation _.___- _._-- p nY �' _ Rock Filled Yes ❑ No E PIT [ ] Depth Diameter Number ---------------------- SEEPA ---------------- Water Table Depth --- ---------------------------------------•-Rock Size ---------------------------------[ 4 m ---- Foundation Prop. Line Distance to ' REPAIRjADD1TlON{Prev Sanitation Permit# --t.-------------------------- --------- Date -------------------- ) �.. r - Septic Tank (Specify Requirements) -----------------I------------- Disposal- Field (Specify Requirements) - ---a.- -------- """"--""" XV ---- - -------------------------------------------- ------------------- ------------------------------ ----------------------- - ----- ---------------- - ------------------- --------------------------------------------- --------- ----------- ---------- - ----- ----- (Draw -- - (Draw existing and required addition on reverse side) , I hereby certify that 1 have prepared this application and that the work will be done in accordance with Son Joaquin County Ordinances, State Laws, and Mules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: permit is issued, I shall not employ any person in such manner "I certify that in the performance of the-work for which this 'as to becom blect to Worktrrahm s Compensation laws of California." Signed ------------------- Owner - ----------------- Title - , --- -- Y ------------ - (If other than owner) 1,11 FOR DEPARTMENT USE ONLY1�09 r-� == ----- - DATE _- :�1 ~ '- ----------------- -- ----- -- -------- --- A��LICATION ACCENTED B --- --------DATE ------------------------------------------- BUILDING ------- -------- -------- -------- ---• BUILDING PERMIT ISSUED �- -------------------- ---------------------------------------------------------- ADDITIONAL COMMENTS ---------------- ----------------- -----------=----------------------------------------------- ---------------------- I -------------------------------------------------------------------------- - - - ------------------------------------------- ---------------------------- ----------------------- - --------------- ------------ ---------------------------- ------ ------ --- ----- --------------------- -- - ---- -------------------------------------------------------- -------- ------ - - - - - ------ ---- -Date Final Inspection b SAN JOAQUIN LOCAL HEALTH DISTRICT +- E. H. 9 1-'68 Rev. 5M