69-346 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: g}�a APPLICATION FOR SANITATION PERMIT � Permit No. ---- - ------ ---- --- ---^� - ---, {Complete in Triplicate} _ -----�--------- .0 � � Date Issued - -- - - ----------------- --------------- This Permit Expires 1 Year From Date Issued al Halth isrict for a permit to construct and insal the work herein Application is hereby made ito the Sin co quin Loian et witheCou�yt0 d nan a No. 549 and existing Rulestalnd Regulations* described. This application JOB ADDRESS/L AT10N . f� 1� "---`'�o� ----------CENSUS TRACT ------------- 5 da }� sem` Owner's Name i[ft" _ 1-C1fL_a]t----- Phone ,A�// City _dr - t1------------- ---------------------- Address �- - -{vl � � �'. _hone ( License # - -� Contractor's Name ------- -- — ------- - . �- 1 ❑ Apartment House❑ Commercial er Court [1Installation will serve: Residence Motel ❑Other ------------------------------------------- ! ot Size Garba --1 Number of living units------------- Number of bedrooms ------------ _ge Grinder ----------- L --- ---- - _ _ - Private - - - - - ----------- Water Supply: Public System and name ---- -------- -------- ------------- --�-.- -"------------------ --- • -- - - ---- --- 1 Silt C!a Peat❑ Sandy Loom ❑ Clay Loam ❑ I Character of soil to a depth of 3 feet: Sand❑ ❑ Y ' --__----- y{ Hardpan ❑ Adobe' ill Material ------`---- If yes,type ---------------- (Plot plan, showing size of lot, location of system in relation to wells'%byildings, etc.,must be pp aced on reverse side.) F t NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK'[ ] --=-=-------------- r------ Liquid Depth ` -- Material---------------------- No. Compartments e3'-s.:- Capacity ------------------ Type ---------------- - --------- - - ' --.-Foudation - ------------------ Prop. Distance to nearest: Well --------------- +F LEACHING LINE [ ] No. of Lines ------------------------ Length of each line r' Total Length ---;;---_---_------ ----•- -----•Y-'---•'----'- D' Box _ __._- Type Filter Material -------------'------Depth Filter Material --------------•! y l -- ------ Foundation ----------------c------- Property Line��;-------' ------ Distante to nearest: Well -__----__ y { Depth - Diameter ---------------- Number -------------------- --- Rock Filled `YJs"[] No 0 I SEEPAGE PIT [ ] P ----- l " ► 1 -Rock Size ------ -=-------- Water Table Depth i Line Distance to nearest: Well ------------------------------- Foundation _--_ -.----... - P --- D -- --------------------1 �Q REPAIR/ADDITION(Prev. Sanitation Permit x# -xat ' t, Y Septic Tank (Specify Requirements) ----------------._- - -- ==� Dispos Field peafy gvir ents] --------- ------ �_ y V ---- - . - } - ---------- l 7- i l (Draw existing and required addition on reverse side)' f in accordance with San Joaquin I hereby certify that I have prepared this application and that the work will be done County Ordinances, State Laws, and*Rules and Regulations of the San Joaquin Local Health Disfrict. Home owner or lieen- sed agents signature certifies the following:` + "I certify that in the performance of the work for which this permit is issued, { shall not employ any person in such manner i as to become subject to Workman's Compensation laws-.of-California." --------------- - Owner Signed ----------------- -4�� ---- 4 'If Tit' -(If otheFOR DEPARTMENT USE ONLYAPPLICATION ACCE ' -- s ` DATE --- --- ------------------- - BUILDING PERMIT ISSUED --- -------------------------- --_�A----------------------------------------------------- ------- DATE ----------------------------------------- BUILDING - --- ADDITIONAL COMMENTS ----------------- f- - ------------------------------------------------------------- r•y r— --------s---------------------- ----- ------- - -- ---- ---- --------�------------ --------- t -"-_ _ ---i---------------------------------------------------------------------------------_- ------- ------------i-- ---- - ----- ---- --------- ----- Dane i�------------------ --------------------- Inspection -- --- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M. .. s _`Z 4 - ;