71-708 - Laserfiche WebLink

Home Browse Search

r 8r FOR OFFICE USE. APPLICATION FOR SANITATION PERMIT --------------- ------ - ------------------------- ------ -\ Permit No. _71-:71-0. F (Complete in Triplicate) This Permit Expires 1 Year From bate Issued 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 wit�hf County Ordinance No. 549 and existing Rules and Regulations. JOB ADDRESS/LOCALy TIION ___ (, __c.1��____- - _t s �- -�-0- --�'-o th-rO-P.....CENSUS TRACT __ _" ------- Owner's Name ---{ - 17 Phone ------------------------------------ Address -------19!°eql--------" -� --- A-0 ----- ---------•--• City -------------------------- ------------------- -- ----- Contractor's Name . 1 si.8_i�Gl�� ,$--------5_e.�tj'_a-----r L\-------.License # _.1-,6tV9+�f____ Phone Installation will serve: Residence ❑ Apartment House❑ Commercial ❑Trailer Court Motel ❑ Other -------------------------------------------- Number of living units:------------ Number of bedrooms ___________Garbage Grinder ------------ Lot Size ____174-4-1-9-46______________ Water Supply: Public System and name ______________________ _______Private t Character of soil to a depth of 3 feet: Sand'❑ Silt Clay ❑ Peat❑ Sandy Loam Z Clay Loam ❑ Hardpan ❑ Adobe-❑ Fill Material ?0--- If yes,type __________________________ (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 wi hin 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TA [ ] ize____ fft Li uid Depth __________________________ Capacity ----------- - -- ype --------------- eal---------------------- No. artmen ss___'_----_---•------ Distance to neoest: Well ____________________________________Foundation ________----___ _____ Prop. Line ____....______________ LEACHING LINE (I No. of Lines ---- --_�--------- Length of each line.------ 6-`!--.--- -_ Tot I Length ___ __L�.'__________ D' Box ----�-_____ :Type Filter Material ___ __� ____Depth Filter Materia ___- '7_�-�--------• -----.------ 0d Distance to nea est: Well -----1_ _f____ Foundation __4V__0------ roperty Line ____ _________________ SEEPAGE PIT [ ] Depth _____________ ______ Diameter _______-__-____ Number _____-________-_______-__ ck Filled Yes ❑ No 0 WaterTable D pth ----------------------------------------------.-Rock Size ------------------ ------------- Distance to ne t: Well ----------------------------------------Foundation ------------- _ _-- Prop. Line ----------.._....... ._ REPAIR/ bD[ O rev. Sanifiafiion Per t# -------- ----------------------------------- Date -------------------------- ----- ) Tank (Specify Requirements) ------------ -------------------- - ----- ----• ------ q y ..- -------------- Septic Disposal Field (Specify Requirements) _______Lx-��i____�` / -~� aC /i--`� iaa rrC l C� `I>k T_----------0/0-Vit----- --------- ---- - -- - ------------- ---- -- - ------------ ---- --- --- ------------------------------------- ---------- ------------- ------------------------------------------------------------------------------- ._3--- --- --------------- - ------------- ----------------- (Drawa 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: ID "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such rnanner as to become subject to Workman's Compensation laws of California." Signed --------------------------------------------------------------------- Owner BY = .. f� -------------- Title --------------------- '`------ (lf other than owner) -- FOR DEPARTMENT USE ONLY ^� APPLICATION ACCEPTED BY -------- t P1'��. ------------------------------- -------------------- - ----- - DATE ------7=---26---{1-------- BUILDING PERMIT ISSUED --- - ------------------------------------------------------- DATE ------------------------------------ ADDITIONALCOMMENTS ----------------------------------------------------------------------------------------------------------------------------------- ---------------•-------,_ ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------- Final Inspection by, L?_.__ 71 Date - = - 7 -- ---------- ---------------- 1 SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M