69-514 - Laserfiche WebLink

Home Browse Search

L FOR FF! E USE: d �_g .6_ ______ APPLICATION FOIL S3�NITATION PERMIT -- - - Permit No.(Complete in Triplicate)--------------------------------- _______________________ This Permit Expires 1 Year From Date Issued Date Issued -___.- _-,1_A7 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 Coun y Ordinance No. 549 and existing Rules and Regulations. JOB ADDRESS/LOCA�ON ._ • .�C�%`�._----_��-- -- ------ �' ��E --.---------CENSllS TRACT -------------------- ---- Owner's Name -------- --------- --•--- --� - --------------- --_ --Phone ---------------------•----•--------- ! Address --------------------------- ------ ------ �%�------- . City '- - Contractor's Name ------------- --�- --------- ------------------.License # L hone h. Installation will serve: Residence 11-Alp–artment House-[] Commercial [-]Trailer Court iEl Motel ❑Other -------------------------------------------- Number of living units:------ Number of bedrooms __= _______ g )`---- Garbo e Grinder, _ __-_ Lot Size e ----------------- 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'❑ 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.) PACKAGE TREATINSTALLATIMENT {No septic tank or SEPT1C TANK seepage pit permitted if public sewer is available w;tghir�2pepfih t,) 1 ------- Capacity - C 7 �� 17/t� �-fy � - CapacitY d �" TYPe '== Matgrlal06__KC----- No. Compartments - ------------- Distance to nearest: Weil -------------��-_�___________Foundation ----__-�a__r___ Prop. Line -..._* ___Z LEACHING LINE Do No. of Lines.----;;L-------------- Length of each line- Total Length/ _f - J_�140415epth ......._... D, Box _ 45.__ Type Filter Material Filter Material __l- 1 � Distance to nearest:-Well ---------- '=-__:-_- Foundation ------------ Property Line -- '............... J SEEPAGE PITY E ] Depth -------------------- Diameter ________________ Number -------- ------------------- Rock Filled Yes (] No i❑ Water Table Depth ------------------------------------------------Rock Size ------------------------------ I Distance to nearest: Well ----------------------------------------Foundation --------------- ---- Prop. Line ----------.---.--_--- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------.-------,.--------------) Septic Tank (Specify Requirements) ------------- - - -------------------------------------------------------- _________________;_.___-___--__.__z_--------- -- Disposal Field (Specify Requirements) ----------------------------- -------------------------------------------------------------k----------------------- -------•� --- - - -- - - - - ----------- - - ------------------------------------------------- 1 {Draw existing and required addition on reverse side) I hereby certify that,l 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, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed Owner ` Y ------------------------------------------------- . ' ------- • itle ........ - +�z �. -------------------------------- {If other than owner FOR DEPARTMENT USE ONLY �+ APPLICATION ACCEPTED BYC'><'-- -- l -- -—--------------------------------------------------------------- DATE ---- --Y - --,------ ------------------- BUILDING PERMIT ISSUED ---------------------------------------------------------- -----------------------------------------------DATE ------------- ----•------------------------ ADDITIONALCOMMENTS --------------------------------------------------------------- ------------------------------------------------------------ --------------------------------- -------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------- ---- -------- --------------------------------------------------------------------------------------------------------------------------------------- ----- -- SAN ------- --- ------------------------------------------------------------------------------------------ -------------- -- Final Inspection by: Date ------`--"------------ i SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M