69-1014 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE- APPLICATION FOR SANITATION PERMIT Permit NO. (Complete in Triplicate) --------/ Date issued --------------------------------------------------------- u This.permit Expires 1 Year From Date Iss ed id install the work herein cal Health District for a permit to construct or n Joaquin Lo 549 and existing Rules and Regulations. rr ----------- ---------------------------- ---- -- - -------- -------- ---- --------- --------------------------------- Application is hereby made to the So with County Ordinance No des.cribed. This application is made I-in compliance -- ------ ----CENSUS TRACT -------------------------- - ---------Z--- ----- -------- ------ P Phone - JOB ADDRESS/LOCAT19_ - -- ---------------- --- - - --------- ityr ---- ---------------------------------------------- owner's Nome --------- Ci ------- .. ......?0-7-------- - --------------------- ------------ C ------------------------------ Address ---------- ------ �r> --------License ------- Phonel Contractor's Nome --------- rail6r Court [1 Residence E] Apartment House,0 Commercial installation will serVe. Motel 0 other�-------------------------------------------- ---------------- ------------Garba-ge Grinder ------------ Lot Size ------------- -------------- A A I_-_private Ntimber of livingWnifs-------------- Number of bedrooms -------------------------------------------------------------------------- Water supplyt. Publi stem and name ---------------------------------- [I clay illoary�o Si It C] clay [I peat 0 Sandy Loom depth 6f 3,feet-. Sond'[1 ty pe ------------1-1&-! Character of Soil to a Fill Material ------------ if yes, ------------ dobe ardpon [I A, A c. must be placeA on reverse side.) 'N., n-of-sys.tern in relation to wells, buildings, et (plot plan, sh wing size of lot, lo'catio ithin 200 feet) Apit permitted if public sewer is available\h I (No septic tank or seepagej LiqA Deoth ---------------- NEWINSTALL T1 N: Size ------------------------i---------- I I SEPTIC TANK{ I -------hi-c-it-erial------------------- Compartments ---------------------- PACKAGE TREATME capacity --- --------------- Type ------------ -----No------ Prop!Line --------- ----- ------ ------ -------- Foundation Distance to nearest- Well ---------------------------- Total tength ---------------------------- ---------I Length of each lim--------------- -1;--- N o. of Lines -------------- ?-r�------------ LEACHINGLINE 36�th Fil;e'r M D aterial V Box ------ -.--- .,,ype Filter Material -------------------- '-lpkop;rty Line ---------- ------------- Foundation -------- ------- r st-' ell --- ------------ Yes 0 No 0 Distance�to ne Ii. Rock Filled IV Numbw -------------- ---- 61 —1*3k SEEPAGE PIT Depth - ----------------- Diameter -------- — ------------------ I .....1----------------------------- .....Rock Size --- ------- "%- J Line -------------- Water Table Depth ------- Foundation i-------------------�Prop- Distance Ito nearest: Well ... ----------------------------------- -------I ..........,�Date ------------- ---------- - ------------- -- D, --- ----------------- AIR/A�DWTION(Prev. Sanitation Permit - 1 'r�, I------------ REP. - --------- �clly Requirements) ------------- --------- ---------- 4------�-V- ----------------- --- ---------------- Septic Tank (SP4 ---------- Disposal Field (Slecify Requirements) -------------- - --- -------------------------------------- P -------------------- -------- -------------------- --------------------------- I ---------------------- ---------------- -- ------- required addi ti o n with San JdaquIn ----------------------- ------- ---!--- 4 on reverse sici`0- dance ----- -- -- (Draw existing an c plicarlon and that the work will b e On6.in-a car or licen- epared this aP ealth Ist1rict. Home a net I hereby tertify that I have pr I of the San joaquin Local H cilth I! es, State Laws and Rules and Regulations County-Oedinanc 110f . y pe on in such manner 4 signature certifies the following: sod agent �ce of the work for which this permit is issued, I shall not employ cin Irs "I certify that in the performa ati*rt laws Of California." as tobecome subjert to Workn;an's COmPOns owner I--- - ---- -------------- --------------I----------- ------------------ Signed -------------- ------------ itle ----------- By ------- -------- -- -- -------- (If 0 er t owner) M T USE ONLY FOR DEPART DATE ---------- ----------------- ----------- ------------- DATE--�� -------------------------- APPLICATIONACCEPTED- ------ ---- -------------------------------------------- ----------------------------- ------------------- ILDING-pErAIT ISSUED --- -------- --------- ------------------------------------ ---------------------------------- BU - "-'1 *14`4 -------------------------- OMMENTS - --------------k- -- -- ---- .0 ) ----------------------- ---- ADDITIONALCOMMENTS ii........*--------------------------- -------------------------------- -- - ------- ------ --------:--------- ---------------------------------------------------- 4 ---------- - ------------ --------------------- ---------- ----- ---------- ------------------ . - .................... --- ------- --- -------- --------- ............................... ----------- ---- ------------ ------------- ------------ Date ------- ------------ ------------ ------------ Final Inspection ��------ - ---------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT r- H 9 1-'68 Rev. 5M