69-428 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE- ----------------------------------- SE: APPLICATION FOR SANITATION PERMIT ------- ---------------------------•-----:--------------- Permit No: (Complete in Triplicate) _________________________________ __ -__________ This Permit Expires 1 Year From bate Issued Date lssued,1�1 Application is hereby made to the San Joaquin Local Health District for a permit to`construct-dHd-i stall the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: J08 ADDRESS/LOCATION .__-- 0=9 IgMidst----i--nRoad, a ® - __ -- --------------------------------------------CEN�S�USr TRis ACT ----------------------.-.-. Owner's Name .11QbOr-t_-- __--- -- ---------•------------------ ---------------------------------------------Phone ............. Address CitYThitcpXa---------------=--- -------- Contractor's Name __ _ ]- '�S_)_� _i7 __S_gxli_ _7 -�Ls---21aC_.. -.-----.License # _18178 ------.Phone A8_ n6_6.1-------- I Installation will serve: Residence ® Apartment House❑ Commercial :❑Trailer Court '❑ 11 Motel ❑Other -- — Number of living u;niti:-_X-___'Number of bedrooms;.__4, Garbage Grinder_=t*__--__ Lot Size 148 .66___x__ 22.-6........ I Th�rn �n ----- s Water Supply: Public System and name ---------- - - i Private❑ _w,.—_C-haracte-r of.,soil to-q.-cEepth of.3 feet.: Sind'❑ It F71" Cllay�❑y Peat❑ $-Sandy Loom -® Clay Loam Hardpan ❑ Adobe ® Fill Material ------------ If ye type_ ; (Plot plan, showing size of lot, location of system in relation to- Wells, b it-i tc must,be.;placed_bn ^reverse. side.) I I NEW INSTALLATION: (No septic tank or seepage pit permitted if publi s r is vnilabl'e within J00 feet,) # PACKAGE TREATMENT [ ] SEPTIC TANK j}L] Size__ _ 1_? �xa6�]1rd------- Liquic�'Depth __4?_74t------- .,...__ Capacity (_ _�12.0 -- Type Comellt--__ ateri _C*ncV'ct_te-No. Compartments .2:.................. Distance to near st: Well `_?_ltd _e-1 ________c_Fou dation -__________ Prop. Line ____...._5.t.,....__ to f ' LEACHING LINE [ ] No. of Lines ---4.------------------ L g each line--.801".-1/-- Total Length ,_��f____.______.___- '_X3 4 r l tV 'D' Box _2__. _ Type Filter Ma i _E�___- _._-'____Depth Filter MNdterial ____: _8____________________•------.-._..- Distance'to nearest: Well _-ti _-ire-11____ Foundation ---1Q_t-------------- Property Line ------1,p_?_____._..__ SEEPAGE PIT [ ] Depth __ __�_.__________ Digm e _ Number __________________.___ --- Rock Filled Yes ❑ No C p f = , ' t i , r Water/Table a th ----- - -------- ------ Rock Size -----------____-- Distance to ea est: e I -- --------- Datundation - Prop. Line ...................... F REPAIR/ADDITION(Prev. Sanitation i { Septic Tank (Specify Requirements) -- ---- - --------F ------ - 1 -•-------- Disposal Field (Specify Requirements) --------------- ----------------------------------- ti - - - ----- - - ------ ---------�; ----- ----------------------------- -- _ =-Y- ------•-- - ---------- - ---- -----.----- -- ---- ----------------------------------------------------- ---------------------------------•--------- I (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 Sart 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 - - ----- r; - rn itt- --- -: Owner, Saai€ nIncy --- - - Fr e S id e n- t --------------------- ------------------------ O-Ke ----------"----- ( ea76 Q ner •l a me n FOR .DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - -- -------------------------------- ---. DATE V----'' ----- -- -------- -- --- - -- ------------------- BUILDING PERMIT ISSUED _--------- -----DATE --.----'- .-...--._-__--------------------- ADDITIONALCOMMENTS -------------- F- ---------- ---- -------------•-- ---------------------------------------------------------------- -------------------•_r------ -------------------------------------------------------- ' ---------------------------------------------- ------- - ---- - -I J------ -- -- -- --------------------------- ---------------- - - --- ------- o Final Inspection by: ------------------ ------ ------------- ----------------- ' ------------------ ate ---------'---- ---------- --•------- SAN - - SAN OAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M.