69-610 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: l A rr,�,N PPLICATION FOR SANITATION PERMIT Permit No: --------------------------------------------------- tel` (Comp .� lete in Triplicate} _ -- This Permit Expires 1 Year From Date 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 with County Ordinance No. 549 and existing Rules and Regv tions: JOB A4XE/SS/L_OCATION �V ��------- f' s-� ----------CENSUS TRACT Owner's Name -- -1�fq-- ----- 7C/G� 4/------------------_ ------ Phone ------ _ Address• 7 �''------`{� --I n 2�"r,, � � =�- City _�Address Name --- �� --- -- -2------------------------------License #, yi� _kPhone O" ------•c� Installation will serve: Residence§r Apartment House❑ Commercial ❑Trailer Court ❑ /--- Motel ElOther ---------------- --------------------------- Number of living units:.____ Number of bedrooms ---I------Garbage Grinder ------------ Lot Size t Private " Water Supply: Public System and name ._h------------------- - -- ------------------------------------------------------------------------- Character ------------- ------------------------------------------------- Character of soil to a depth of 3 feet. Sand Sift❑ Clay ❑ Peat❑ 'Sandy Loam •❑ Clay Loam ❑ Hardpan ❑ Adobe-F-1 Fill Material ------------ if yes,type _______________________-___ (PI'ot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: JNo septic:tank or seep❑ pit permitted if pubic sewer is available within 200 feet,] s y PACKAGE TREATMENT [ ] SEPTIC TANK Size-_____ __�-_ --C� � - ---- Liquid Depth ____Y� -------- �� b!2_P-Cu4aterial- on No. Compartments Capacity ��----- -- Type !` _�.------•---:.... 46------ ----- Prop. Line ---`5---- •----- Distance to nearest: Well �__ _ _________ ______Foundation - _ LEACHING LINE [ ] No. of Lines ---_-- _- Length of each line_______ J~_-_--------- Total Length ----7-rJ-------------•---- D' Box -----.____ Type Filter Material`-C`C.--:---Depth Filte Material --/__7-- -------•--------------.......... �/ Distance to nearest: Well--------- Foundation __/a------------- Property Line ------------------- F SEEPAGE PIT' [ ] Depth "-------------- Diameter Number -__---- ---------------- Rack Filled Yes ❑ No is -------------- Water Table Depth ------------------- -------------- - - - -------Rock Size -------------------------------- - Distance to nearest. Well ----------------------------------------Foundation -------------------- Prop. Line ..-----•-•-----•------ REPAIR/ADDITION(Prev. Sanitation`Permit# -------------------------------------------- Date __________________________________----------------------------------------------------------] 1 Septic Tank (Specify Requirements) _ --------------------------------: Disposal Field �(jS,pecify Requirements] _____F.��141K-------Ext--$n;r4�------- ------ 9r -a _ P C b17T1E9 ---�)4N_K---- WI-T-H-----1 ,_-- 'i4�- .----�R------ "' �r� --------------------.••---- h - ------ v P1FX---------KIr-D4 4 I (Draw existing and required addition on reverse side) .0 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 liten- 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 become subject to Work an.'s Compensation laws of California." fSigned 4 Owner �. _ Title ------ - ---------- ---------------------------------------------------- BY ------ t ------- -- -------- -- -- --------- ------------- (If other than owner)' FOR DEPARTMENT USE ONLY 1 APPLICATION ACCEPTED BY - ---1-t-R-0---------------- -------------------------------------------------------------- DATE -----7___ 11 BUILDING PERMIT ISSUED --- ------------------ ------------ -------DATE ------------------------------------------- ALCOMMENTS ---------------------------------- ---------------------------------------------------------------------- - ADDITION ____ ___________ _-_______-____ ------------------------------------------------------------- 4 -- __---------------------- ----- --- -- ------------ ___ _ ______- ______ ___ ___________ _ __ ---- ----------------.----------------------------_------------------- Date ________ _________Da e ----- Final Inspe .y SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M