72-476 - Laserfiche WebLink

Home Browse Search

} FOR OFFICE USE: APPLICATION FOR--M-NITATION PERMIT a,,\ Permit No: --7.--- 4 ..,.,,., (Complete in triplicate) € f --- --- ----- ---- �-`-r------ -------------�'•"" ...� �'"_ •�VLIV f �, ;� e p �f Date Issued __,�_-�"-�� This'.Permit Expires ] Year From Date Issued `f -------------------------------------.------ ------------- ork Application is hereby made to the San Joaqui nYL-ocal..Health District for a permit to construe#and install the work herein described. This a lication is made':in comp idnce with tounty�,rclinance No._549 and existing Rules and Regulations: P - . JOB ADDRESS/LOCATION C?I-l-_ ! �--= �- CENSUS TRACT Owner's Name t_�1 `lf �rPhone --- Cit Com' - Address ---- - .�---------------------------------------------------------- Y - Contractor's Nam �r--/ iS�- - }/cam �� --- -_-----License #p'�1 fes Phone Installation will serve: ResidenceKApartment House❑ Commercial ❑Trader Court !•[ Motel ❑ Other -------------- --------- ------------•-- i 3 Number of living units:--/-_ -- Number of bedrooms -1'9 ---_Garbage Grinder Lot Size . _- ' i Water Supply: Public System and name - �/�` fl��---!✓Z- - �f� =- Private ------------------ a I Peat Sand Loam Clay Loam Character of soil fo a depth,of 3 feet: Sand'❑ Silt.0 Clay ❑ ❑ Y .r •- Hardpan Adobe Fill Maternal ------------ If yes, type -- --- �i ells, buildings, etc. must ' e placed on reverse side.) (Plot plan, showing size of lot, location of system in relation to w ` NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available w�t�hin 200 feet,) .V SEPTIC TANK' Size- / _ tLiquid Depth-------------------- PACKAGE TREATMENT I ] °�� - r Material /_��---- No Compartments --------- �,.� CapacitY�----•-- TYP = -'� / - ----- --- F, Foundation _ Pro Line __ ��-- -- Distance to nearest: Well ------— -------- / - p' LEACHING LINE y No. of Lines ___ --------------- Length� /ofach line---b__+�'-------� . ----- Total Length �� ----------V �l� P �7 D' Box _# - Type Fil#er Materia f}, - Depth Filter Material .-_---------•----------- -- ! sem- -_ Distan a to nearest: Well ------------------------ Foundation _ ---------------- Property Line. - -_-- - •---------•--• . SEEPAGE PIT P(] Depth --------- Diameter Number ----� --------------- --Rock Filled YesX No 0 1 Water } // / t Table Depth ----fir ----------------------------------Rock Sized--'--'-�--- -- / w �� Pro Line ..F�Y---- � Distance to nearest: Well _-__`-____� ------------------------Foundation ___ __ _____-______ p. � REPAIR/ADDITION(Prev. Sanitation Permit# ------------------ --------- Date ---1 Septic Tank (Specify Requireme its) ---- ---------- ------------------------------------------------------------—-------------- - - ------------- --_--------------------------•-- Disposal Field (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 certifies4lie 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." iOwner R fi' ------ Title . -------------------------------------- BY = ------------------- `�` other than owner) ,f: � FOR DEPA' RTMENT USE ONLY I'�7� APPLICATION ACCEPTEDIBY ----- ---------------r --------- ------------------------------------------------------ DATE .-- _ - - BUILDING PERMIT ISSUED ------ - - -- --- --- --- - DATE ----- ADDITIONAL COMMENTS ---- T - -�i� 4 - -- ----- ----- �s ; /� - - -------------- --------------------------- � __ _____ - - ---- ------------------------------------------------------------------------------ --- --- - -- _ .. - --- -- ---- Final Inspection by: ------------------ Date --- -------- ----- ------------ ! SAN JOAQUIN LOCAL HEALTH DISTRICT �tFs��•�ti��+q ,4� �.* ..... x`}514 r '{� E. H. 9 1-'68 Rev. 5M _ 1v _�-