71-735 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: y APPLICATION FOR SANITATI N ERMIT �. --------- ----------------- ----- Permit No. f lZ - - - - - - -------------------------'----�:- m Triplicate) _-..r_-��. - C��f¢/ (Complete .r .,� Date Issued -- -/ __________________ "" "'" This!'eririit Ezpires 1 Year From bate[ssued Application is hereby made-to the Son,Joaquin.Local Health District for a permit to construct and install the work herein described. This application'is made incompliance with County Ordinance No. 549 and existing Rules and Regulations: JOB,ADDRESS/LOCATION..__.-- -- !v4_ -kr ----- ----- --- --CENSUS TRACT ---------------------_-_ I Owner's Name ACX = P ones_ -r �J�-9- --....._ t n s . -_ -Address ---- --- -- City 'atLicensu# .IO�1�------ Phone Nam Installation will serve: Residence ❑ Apartment H use Commercial:❑Trailer Court ❑ ; ir -�► r Motel E]Other-4 _. �.; ®�� Number of living units------ Number"ofsbedrooms ___+w_Garbage Grinder ------------ Lot Size ------ 1-__=____—______- ----------- Water Supply: Public System and name ------- Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay .❑ Peat ❑ __-Sandy,Loam)< Clay Loam Hardpan ❑ Adobe,:E] Fill Material -.---------- if yes,type ---------------------------- (Plot ____._ _ ----_-_______-_(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 "Of] -� EPTIC TANK � Size------ �x�' -------------------- Liquid Depth __- CapacityI� --------- Type hex'____ Material_ -_. No. Compartments ____ ........ Distance to nearest: Well ------ d-�_ -_____________Foundation -----10_f '.___ Prop. Line LEACHING LINE `uf No. of Lines ------- -------- Length off each nline------7Q--------------- Total Length ,,1.-f__0-_____........ D' 1�+�_-_-rL� :Box i-- Type Filter Material _ _ _ ___Depth Filter Material ---1.04---------._-____________________ Distance to nearest: Well --------- Foundation ------/_0 t_____ Property Line ._-_�� ...... SEEPAGE PIT [ ] Depth ---------_--------- Diameter ----------______-Numbet_'•:�___..._______________..__ Rock Filled Yes ❑ No i❑ Water Table Depth ---------------------------------------•--------Rock Size--------------------------------- Distance -------------------------------Distance to nearest: Well ----------------------------------------Foundation,L.------------------ Prop. Line -------.__.._----_---- REPAIR./ADD[TIONjPrev:Sanitation'Permit'#""=_-_.--'_------ ..-.� .�_ -` DateAl— Se ..�. SepticTank (Specify Requirements) ------------------- --------------------------------------------------------------------:-----------------•---------------------------- DisposalField (Specify Requirements) ------------ ------------------------------------------------------------------------------------------------------------------------ -- --- ------------------------------ ----- ---------- - ---------- -------- --------- -------------- --------------- ------------------------ E ..., - - - ' (Draw 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: I V "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manna* as to become subject to Workman's Compensation laws of California." Signed ____________ __. Owner - -------- --------- -------------------------------------------------- r" ` Title BY --- ---- - _ = ---------------------------- ' - (If t er than owner) " - r ' Y i = - , FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - r -------------------------------------------------------- DATE --- ��>Q '7 l----------------- BUILDING PERMIT ISSUED .-•------=--------------------------------------`---------------------------------------- -------DATE ------------------- --------------------- ADDITIONAL COMMENTS --------'------------------------- -----------i ----------------------- i i ----------------- �i --------------------------------------------- --------------------------------------------------- ----------------------- -------- -•------------------- --------- - tib. �. I s ► Final Inspection by; ---- --=: -------------------- - ------ it ----.Date - ------------------- . -SAN-JOAQUIN ,L•OCAL -HEALTH -DISTRICT - E. H. 9 1-'68 Rev. 5M