69-987 - Laserfiche WebLink

Home Browse Search

FOR OFFICE: USE: APPLICATION FOR SANITATION PERMIT - - ---- -- --------------------- - Permit No. �-I--'-my (Complete in Triplicate) ------------------ ----------------- Date IssuedThis Permit Expires 1 Year From Date Issued i 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: 'N. of i)urba.m erry ----- NSl1S T g� 1` JOB ADDRESS/LOCATION ----2911S>�@---- {03C�i---TC-3r------------------------ - C Its+ Owner's Name ------------------------- --------------------------------------- -------Phone ------------------------------------ ------------ ------ S C 'iZ'3I1 Cdr City ----T-x_�C-Y-----y---- --------------------------------------=-------- Address 2 673Pa1TIl St___p1LmbContractor's Name --- ----------- iig---s.er tae---------------License # -----99.594___ Phone $35-3114--------- i Installation will serve: ResidencellApartment House❑ Commercial ❑Trailer Court ;❑ Motel ❑Other -------------------------------------------- Number of living units:----I----- Number of bedrooms ---------- Grinder ------------ Lot Size ------A ceraga--------- Water Supply: Public System and name ------------- - -----------•------- -------------------•--;;-- n------;,-----.------;�.;-----LL--------_-Private n� Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe-❑ Fill Material- If yes, type -------------------__---_- r (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 seweQis dVailable within 200'feet,) ' PACKAGE TREATMENT [ I SEPTIC TANK [X. Size--_5!V ht!__x9 ------- - -- Liquid Depth ---- 8n--------- .- P 1200 0 Capacity -------------- Type Material ��eNo. Compartments ------.-2 ____....-_••__ , Distance to nearest: Well ---75!--------------------------Foundation _-i-----1��_----- Prop. Line -----5Qi-:__------ LEACHING LINE [X- No. of Lines - 3.--------. Length of each line------ ---- -- Total Length ,--_-2�91 'D' Box ___.__-.-- Type Filter Material 3-gpt_.__RkPepth Filter Material ------ -----------------------------•-^ Distance-to•nearest: Well ---$5-F------------- Foundation SEEPAGE PIT [ ] Depth ------- ------------ Diameter ---------------- Number -------------- ------------- Rock Filled Yes ❑ No I❑ WaterTable Depth ------------------------------------------------Rock Size '------------------------------ Distance -----------=------------- --Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ----------------.---_ 4 REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date --------- -------------------- ) t Septic Tank (Specify Requirements) ----- ----------------------------------------------------------- - ----------- Disposal Field (Specify Requirements --------------------------------------------------------- ;f------------------- ----------•---------- -------------------------:--- Y E M - ' It f # ------------------------------------------------------ -------------------------------------------------------------------------------------------------------------- ---.------:-------------------- (Draw existing and required addition on reverse side) , I hereby certify that I have prepared this dpplication 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. Hpme owner ar licen- sed agents signature certifies the following: ( � • "I certify that in the performance of the-work for which this permit is issued, 1 shall not employ any person in such9manner as to become subject to Workman's Compensation I ws of Calif rnia." Signed _..PA;jKQ'gIST---PLUMBING---SERV- -- - --- -- � ` By ------------------------------------------------------------------------- Title --Ma.I ag-er'-------------- -------------------------------- (if other than owner) ' ! x FOR DEPART M NT US O LY APPLICATION ACCEPTED BY ---------- ------------------ '~ DATE -7-------------------- BUILDING PERMIT ISSUED --------------------t---- ,. ------ DATE ADDITIONALCOMMENTS,-..------------------------------------------------ -------- ----------------------------:---------------- ----------------- ----------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ - ----------- -- --------- ------------------ - -- - -------=------- FinalInspection by: --------------------------------------- ------------------------------------ -- -------- �r__Date SAN JOAQUIN LOCAL H ALT DISTRIX E. H. 9 1-'68 Rev. 5M.