69-205 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT - ----------------------------------------- ermit No. .�.�=�2�5� ------------ 366-OCT (Complete in Triplicate) ��_ ---- ..I----------------------------------- Date Issued __ ...:�-=� This Permit Expires 1 Year From 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 CountOrdinance No. 549 and exi ing Ryles ar} Regula ' r Aim!f ALT�E1A - s JOB ADDRESS/LOCA O --0.<_�-------- '�� C/ L't-- i4 1 EN SUS T ACT t iPS- t lzn��-t �A-�mr 1 a-avp-.--------------------- ----- ------Phone��.� ----- /--------------- Owner,s Name .____,r� Address i.�� [� D. y�7R._c /} city - Contractor's Name f-- --- ti - f" •_.License # ------------- --"----" Phone 4-4f( Installation will serve: Residence [Apartment House❑ Commercial {]Trailer Court i❑ Motel ❑ Other -------------------------------------------- J Number ------------- --------------------------- Number of living units.-..-/ Number of bedrooms _...-Garbage Grinder A-()--- Lot Sizer -� _'2+ rvQ------- Water Supply: Public System and name ------------------ "------------------------------------•---------------------------------------Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ PeatSandy Loam X Clay Loam [-]Hardpan [-1Adobe'❑ Fill Ma _ __ " terial P--- If yes,type ------________-___________ (Plot plan, showing size of lot, location of-system-in-relation to-well s,.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_.G!A_P't-K_475__a---------1- Liquid Depth _ _______________ ((}} _.1 s Capacity �_�t_0Q_-___ Type[�,�.�-" Material�Er�.E -_� No. Compartments ..__Z------------- Distance to nearest: Well _____•-----__-._- Foundation ----1-�-�------ Prop. Line -.--- LEACHING LINE No. of Lines _ Length of each line---- �_4p--r---------Total Length ,__.____, /i ', D' Box ____-""--- - Type Filter Material. :� Depth Filter Material --- ., ._............ ...............•- Distance to nearest: Well __c5- -r------- Fou ation ..- �_ �___�. Property Line _""" -------- ...... SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number ------------------`__------ Rock.Filled Yes [] No C] Water Table Depth ------------------------------------------------Rock Size ----- -------------------- Distance ------------------Distance to nearest: Well ------------------------------ ------Foundation -------------------- Prop. Line ---------------------- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date --.-------------------------------I SepticTank (Specify Requirements) ---------------------------------------------------------------------------------------- ------------------------------------------------------ Disposal ------ ------------ - •--------------------.-•----Disposal Field (Specify Requirements) - ---------------------------------------------------------------------------------------------------- -"'` ------- --------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ -------------------------- -------- ------------------------------------------------------------------------------------------------------------------------- (Draw existing and required addition on reverse side) I 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 bec a subject to ork an"s Comp sati.on law of C¢}�fornia." Signed ... . -1 BY --- -- - - ----- �` : Title (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------� ------------------------------------------------ -----. DATE ----- _-_. .` " BUILDINGPERMIT ISSUED -------- ------------------------------------------------------------------f --------------------------DATE --------------------------- ---------- COMME�,Vmmrl NTS --------- -----------------------------------•----- ------------------ ---- ------:-------------------------- --------------------------- --- -- -- ------------------ -------- - ------------------------------------------- ---------------- ------------------- -------- ------------------ ------- -- --------------- -- ---------------------------------------------------------------------------------------- ---------------------------------------- --- -- ------------------- -------- ---- - - ---------- -------------------- 29 Final Inspectio Date ._.._ _-- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M.