70-397 - Laserfiche WebLink

Home Browse Search

FOR OFFICE 1dSE: APPLICATION FOR SANITATION PERAlIIT Permit No. --------------- ------------- ---- lD'------ ---- [Complete in Triplicate) %� ,1• Date issued -��----- --1�--• _ ---- ��----- This Permit Expires 1 Year From Date issue 1 the work and A lication is hereby made to the San inal Health District for a No. 549 and exisrmit to ting Rulestalnd Regulations- Application described. This application is made'incompliance CENSUS TRACT ------------ - JOB ADDRESS/LOCATIO - _ 141 fir `] / Phone ----°-------------------=--- Owner's -Owner's Name ------ -- -- ---- t city "------------------------------ ----•-- l ------- --------- ---- _ Phone ------------------------------ Address �- - License # Contractor's Name ----------- - Residence Apartment House ' ❑ Commercial :(]Trailer Court ] Installation will serve: Motel ❑ Other -__-_ -" --- ��, Garbo a Grinder - ---------- Private lot Size -------------- ---------- Numbe r of living units-"-__ "__" Number of bedrooms 9 Private - - ----------------------- ----- Peat❑ Sandy Loam �('] Y Water Supply: Public System and--name '------- -=---- ------ -- --`-- - " - . Clay Loam Character of soil to a depth of 3 feet: Sand C /5 Adobe (] Clay [� �. L,�/ y e --=------------ ---------- _Hardpan- Adobe ❑. Fill Material._ _ If• es;type + ` buildings, etc. must be placed on reverse side.) (Plot plan, showing size of lot, location of system in relation to wells, # NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) (' J i L LiI Liquid Depth -------------------------- Size -- 1 PACKAGE TREATMENT [ ] SEPTIC TANK'[ ] Size------------- - a _ ." - • Capacity ------------ ------ Type --------- -- -_"-"- Material------ --------------- No. Compartments -- -- Distance to nearest: Well --------'- ------------------------ Prop. Line ._".------ ► LEACHING LINE [ ] No. of tines -------------------- Aength of each line."-------------- Tota Length Depth Filter Material ---------------------------------- --------- 'D' Box -------- -- Type Filter Material ----------------•--. P i Distance to nearest: Well Foundation -.------- ----------- Property Line. ------- -------------•-- -------- Number -- ------------------------ Rock Filled Yes 'C3 No SEEPAGE [ ) Depth -------------------- Diameter -j" Table Depth ---------------------- --------- Rock Size -------------------------------- Water ------------ ------ Pro Line --- ---- ---- ""-__"_""_".-"_.__Foundation - P• Distance to nearest: Well --------------------- REPAIRfADDITION{Prev. Sanitation Permit -------- -------- - - = Date ---------------- ) : (Specify Re Septic Tank (Sp Y uirements q -------- --- - -- s4tb�� D' al Field (Specify Requirements) �tic> " :.�� ------------ k ={Draw existing and required addition on.reverse sr . .F k will be de in accoance San Joaquin the wor I hereby certify that I have prepared this application and thatofthe San Joaquin Localok[ealth District. Hometowner or licen- County Ordinances, State Laws, and Rules and Regulations sed agents signature certifies the following: 111 certify that in the performance of the work for which laws this Cpermit is alifornia,issued, I shall not employ any person in such manner 1. as to become subject to Workman's Compensation ------ ------- - --- - - --------------• Owner ---------- - ( Signed ----------------------- - ----- Title I - ----- - - - - - (lf o#her than owner) t FOR DEPARTMENT USE ONLY DATE k-P_ ---------;•- APPLICATION ACCEPTED BY . ----------------- "- ------------------------- - - DATE --------------------------------------------- -------- --- BUILDING ------- -------------- BUILDING PERMIT ISSUED ------------------ -------------------- - r - ADDITIONAL COMMENTS ------ ----------------------- --- ------.-------------------- • f - --------- ----------------------------------------- ------------•------------- ---------- ------------------------ -------------- --------------------- - - ------ ---- --- _-- = - _..DaTe -- -------------------------- ------ Final Inspection by: -- -- ------------- ----- �,i7'° ° SAN JOAQUIN LOCAL HEALTH DISTRICT `; : . E. H. 9 1-'68 Rev. 5M