70-89 - Laserfiche WebLink

Home Browse Search

� FOR OFFICE LISE: f' APPLICATIOJ4 FAR SANITATION PERMITPermit No. _'4-�----- -------------------------------------------- - - (Complete 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 Regulations: . �/ A-64-/P'+ CENSUS TRACT $ `7 7 JOB ADDRESS/LOCATION 2_6_-=-��-,�- ---:----- E-- f7 - -------- - -----------0---- -- - Owner's Name --Phon 41k®-- -� GP / - - Address � f �---- �-r-�--'---- W .D---------------- - City A10r C/1------------------ --p----er------------�-•--@--�-------- Contractor's Name -- 7�XA,41 ------- --------License #_-;2,5- - --"--- �----- Installation will serve: Residence PI-9p-artment House❑ Commercial ❑Trailer Court ;❑ Motel ❑Other ------------------------------------------- Number of living units:--,--/----- Number of bedrooms cam1 _-.-Garbage Grinder..�i?__ Lot Size. A? --------------------------- Water Supply: Public System and name ------------ --------------------------------------------------------------- ------------ ---------------------Private Character of soil to a depth of 3 feet: Sand'0 Sift❑ Clay M—'Peat❑ Sandy Loam -❑ Clay Loam O--- i Hardpan ❑ Adobe ❑ Fill Material ------------ 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 ublic sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK [ Size --------- Liquid Depth - ---------------- Capacity,��IlJa Typed _ -(W_?'_MaterialC0 No. Compartments �___------__--- �► Distance to nearest: Well __ __________________"______.Fouppn��dation /V--------------- Prop. Lin -----=-------- LEACHING LINE [4. - No. of Lines -.2— Length of each line__d- ------------- Total Length ----------- / 'D' Box ._ _�_� Type Filter Material�C.�------Depth Filter Material _!__C!-- ---------------------••--.--•---•-- Distance to nearest: Well __6a______________ Foundation ____ Property Line ---_____-_-..___-.....__ SEEPAGE PIT [ ] Depth -------------------- Diameter -------- ------- Number -____--_______-----_- ----- Rock Filled Yes ❑ No 0 WaterTable Depth ------------------------------------------------Rock Size -------------------------------- Distance to nearest: Well ----------------------------------------Foundation --------------------- Prop. Line ---------------------- REPAIR/ADDITION(Prev. Sanitation Permit# ----------------------------------------- - Date ----------------------------------) Septic Tank (Specify Requirements) ------------------ -------------------------------------------.i---------------------------- DisposalField (Specify Requirements) ------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------- -------------------------------------- -------------------------------- ------------------------------------------------ - ---------------------------------------------------------------------------------------------------------------------------- (Draw existing and required addition on reverse side) I hereby certify that 1 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 become subject to Workman's Compensation laws of California." Signe Owner _,_ r �__ Title c -w-^: ✓- _-- f f other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------69"Z-0,44- -�------ - -------------------------- DATE BUILDINGPERMIT ISSUED ----------------- ---------------=--------------DATE ------------------------------------------- ADDITIONALCOMMENTS ----------------------------------------------- -------------------- ------------------ -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------1---- ------------------------------------------------- _ _ - _ ----------------------- - ----------------- ---------------------------Dafie---::- _ /:" - Final Inspection b . SAN JOAQUIN LOCAL HEALTH DISTRICT k E. H. 9 1-'68 Rev. 5M