69-202 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ------------- --------- --=--------• Permit No. _�T (Complete in Triplicate) ---------=------------------------ ''// --------------- This Permit Expires 1 Year From Date Issued Date Issued ...174760.. Application is hereby made to the Son Joaquin Local Health District for a per it to construct and install the work herein described. This application is madelin compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ._ 02'�-_-jr�±-li�------ S-t------ --4:ZZ44j-CENSUS TRACT-21�7- -------------- Owner's Namep aG. - - r -. Phone --, � 3r7 Address -------=--------------------- �t�- ¢- - - - ----�----- � ---- ------- - Contractor's Name --._ Qt "4� -``�---+�- City� '�:, sLlicense # g �6- Phone Installation will serve: Residence partment House,❑ Commercial :❑Trailer Court i❑ Motel ❑ Other ------------------------------ ------------ Number of living units:.___.`--_ Number of bedrooms -.3-----Garba_ge Grinder - �__ Lot Size _-_-f7�/-9_ S------- t Water Supply: Public System and name -------------------------------•-•-----------------------------------------------------------------------------Private F4- Character of soil to a depth of 3 feet Sand❑ Silt:[:] Clay ❑ Peat❑ Sandy Loam Clay Loam 'E] .. •� _ _ ,Hardpan-❑ Adobe X Fill Material _____.__-- If yes,-type—.__--.__-_-_�_____ -- i (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 TANK [9d Size------ d-Q------------------------ Liquid Depth ----- ---------..--,----- 1 . -�---_.._. Capacity .�------------ ---- Type _____._______ --- Material- - -- _ _ No. Compartments --------____-- ,t If Distance to nearest: Well -------7iO---'f-- -------------Foundation ---IS Prop. Line ---4----_--------•- LEACHING LINE { ] No. of Lines ---- ------_-_---- Length of each line-----_--�Q-F.-.- Total Length —A-Y. -- __�o_---------- A 1, 1� r/ 'D' Box --- ------ Type Filter Material --- - - nal ---��--- -�.�- -------.-- s _ : ., -o -. � Fo ----- r LLer Line. ._ , . Distance'to nearest:'Well __ _`------_ _- SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number ----- ---------------------- Rock Filled Yes ❑ No 0 Water Table Depth ---------------------------- -----------------Rock Size -- -------- ------------------- Distance to rest: Well ----------------- -------- --- ----Foundation _____ --------- Prop. Li a ---------------------- REPAIR/ADDITION{Prev. Sanita ' n Permit# -------- ----------g _ -- ------- Date --- --------- -----------------1 Septic Tank (Specify Requ' ements) --------------------------------------------- -------------------- .4 Disposal Field (Specif Requirements) --- --------------------- -----------I------ - ------- --------- --- ---------- -- --------- -------------------- ---------------------------- ------------ ------- -- - -- ------- --------------------------------------- --- ----------------- -------------- `. =7'� ------ �-=�--- - -------------------------------------------------- . = , ._ _. - Dr. an 'require ddition on reverse-side[' -71 I hereby certify at I have prepare r kation and that the work will be do im(-e cco ce with San Joaquin County Ordina es, State Laws, an u -sad Regulations of the San Joaquin E i trict Home owner or licen- sed agents sign ture certifies the followi "I certify that i the performance of the rk for which this permit ' I sh t y person in such manner as to become su 'ect to Workman's Compensation laws o i 10." ] ' Signed ---- --------- ----------- -- ------ ---------------- ----------------- e ----------- --- ------------- -------------------- ''' ------ --- --- -- BY - -------- (If other tha ow ,,: OR .DEP,- NT USE ONLY APPLICATION ACCEPTED BY ----------- ----- 4 L 'D -- -i --. ----------••------ BUILDING PERMIT ISSUED --------------------------- ' - - -- - 'DA ADDITIONALCOMMENTS ------------- ------ =- ------------------------------------ ---- ----------------------------------------------- -------------- ----------------- --------------------------- -------------- ---------------------------------- --- ----------------------------------- ----- -- -------------------------- -------------------- - - -- ------------------------------------- ----------- - - __ Oi --- -- --------- ----------------------------------- -- - -- --- ----- ----------------------------------- -- Final Inspection b -- - ---- ------',Date __- 1 SAN JOAQUIN LOCAL H DIST E. H. 9 1-'66 Rev. 5M