69-132 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: '`' < APPLICATION FOR SANITATION PERMIT -------- -----------=--------•--- Permit No. (Complete in Triplicate) _.-._________.___________ -------------- I This Permit Expires 1 Year From Date Issued ©ate Issued 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 County Ordinance No. 549 and existing Rules and Regulations: - ----------v(1// !V t - JOB ADDRESS/LOCATION .--J.S5/LOCATION .---- -�� 3�D 5-5 -IT _1 __. _._CENSUS TRACT ------- -_•----------- Owner's Name __ cJ CYC 1c1� -T - t �z �_f - ------�. rn'�------------ -------------------Phone . _ _- C -------- 'Address.:_--- ~_'"_` '1 �`:" f,Q/----------------------------------- Cit .4J�.IV_T_aC_ t Y q- ,e� Contractor's Name. / i _ 4 '6i�J t�r ---------- p Q •� Z� License #�FJ.�Z ----- Phone ��_--`----�----•-•- Installation will serve: Resid ce ❑ Apartment House❑ Commercial ❑Trailer Court ;❑ Motel ❑Other __Nvf _ ----tlU/►I_ . Number of living units:.__- Number of bedrooms _Garba_ge' Grinder'_^_____ Lot Size ...ACKEA_G_�.............. Water Supply: Public System and name;= ---:--------- ------------------- ---------------------- Private [d}� Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam -[.Clay Loam ❑ r Hardpan ❑ -..Adobe ❑..Fill Material Wo___ If yes, type ------_------------_____.___ (Plot plan, showing size of loft, location of system in relation to wells, buildings, etc. must be placed on reverse side.) ' NEW INSTALLATION: (No septic tarfk.or seepage pit-permitted .if-pvblicisewer is available within 200 feet,) A fir-- X � - PACKAGE TREATMENT { ] SEPTIC TANK [ : Size_. ________ __ LiquidTbepth Ca act C, �. p tY _�-'��.--0�-.- TYPe -1-��FA�T_ Material'_(�ONC_�.�_ �o. Compartments ---�'�--�--.=.--- ----------Foundation -I --t p. Line . -._...--------------- LEACHING .. " Distance to nearest: Well __ __-_ _ ----- LEACHING LINE No. of Lines �" l _ _ [�j� _________�-----____-- Length of each line------ Tota! Length ______��-_-__-------- 'D' - -- ''ox A/Q__ -_ Type Filter Materia! -t vC ' Depth�Filter Materia! --------- ----------------------------- /Distance-to-nearest: Weil —__'_-�- - '; Fo�ndat�on .__------------------- Property tate -�c---_-;-------------- SEEPAGE PIT [ ] Depth -------__-- Diarrieftr; ------------- Number -�-----:---'--------------- Rock fdW Yes ❑ . !Ho Q Water Table Depth ------------------------------- ........Rock Site ---- --------------------------- Distance to nearest: Well ---------------------------------:------Foundotion____--------- ------ Prop. time ---------------------- 2EPAIR/AflOInOM(Prev. Sanitation-Permit# ,.____ r--------------------------------- O --------------------------------- Septic --------------------------:____ Se tic Tank (Specify Ya uirements ---------- 1 ---------------------------•-----.- ------------------------------------------- ,%------------------------------------------------------------Disposal Field .(Specify Requirements) .-.------------ -------------------------------------------- -----------------------------------------------------•------------------ -------------------------------- -------- --------- -------------------------------------------- v - ,, ;i IDraw existing and requredaddi#ion o_n_reverse•side) i F � I hereby certify that I have prepared•this application and that the work will be Arne in,attendance with San 19"win County Ordinances, State Laws, and Rules and Regulat i rn of t&V San Joaquin.Local Health District. Home owner or iicen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued,il shall not employany person in such manner as to become subject to Workman's Compensation laws of California." Signed ---- l� _ Owner --=-------------- - ---- BY ----------- ------------- Title --------- (If other than-.owner) z FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---- f J -------------------------------- ------- DATE _ ¢---------- /__ BUILDING PERMIT ISSUED ---------------------------------------------------------------------- -------------------------------DATE _--- ----------------------------------- ADDITIONAL COMMENTS ---------- ---------------------- - ------------------------------------- ------ ------------ ----- -- ----- ------------p - --------------------------------------------- ------ -------___-------- ------- - - _ ----- Final Ins ��t ` � '� .\ -- -- " a --------------- ---- -- --- --- _ �, Date "T ► SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M.