68-544 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -------------------!;77/z-- - - (Complete in Triplicate) Permit No: ---------------------------- This Permit Expires T Year From Date Issued Date Issued _CIZZ 1__6 07! ( gr UroS 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 ul s nd Regulations: JOB ADDRESS/LOCATION C�,I rxGa- ----- ------- --�..��—,&C SUS ._........-�.-•- - -- Owner's Name ------------- -- -- - - - -------- -Phone ------------------------------ Or Address - ------------- ----------- c7 �--------f---------------- City -- Contractor's Name ---------------- --G_ -----'_- - =� t - ---- Phone License # 1 _ Installation will serve: Residence ❑'Apartment House-O'Commercial :❑Trailer Court . [� ! Motel ❑O'ther--''"_- - -- --- �--- _•-_ Number of living units:_______ Number of bedrodZn _G rbage Grinder ________. Lot ize ---_ -1 Water Supply: Public System and name ; .v--- __ _ ___________________Private I Character of soil to a depth of 3.feet: Sande Silt lay Peat Andy Loam ❑ Clay Loam,❑ Hardpan-Dr Adobe ill Material ------------ If yes,type ---------------------------- c (Plot plan, showing size of lot, location of systemrin relation tel 1o wells, buildings, etc, must be placed on reverse side.) NEW INSTALLATION: (N��PTIC tic tank or se p ge pit permitted ifspublic sewer is, vailable within 200 feet,) PACKAGE TREATMENT TANK [ ] Size _x _ Liquid Depth � .__.._ Capacity JYPe Material _ __ _ -- mentsQNo. Com - art istance to nearest: Well __��7J ____ _________________Foundation ___l �__--------- Prop.Prop. Liner- �o.- .q' i ,�- _�___�_ Total Length LEACHING,LINE [�No. of Lines ________/______________ Length of each I:i e__.___�f�= --- 'D' Box __--_ Type r r1` repth Filter Material --------/ ,�. __ T e Filter Material�IZG __a- _ +�` ________ ' �Foundati [ } Distance to nearest- Weil ______________ umberon___.,.___.V ___ Rock Filled Yes' No , SEEPAGE PIT Depth � � � - ------ -- Water Table Depth ------------- .Rock.Size _------_ , ZjDistance to.nearest;'WeIIY__________,e___ _ ---1 `?___Foundation ____________________ Prop.-..Line'___-.._._�.....__.. ---- ------ } REPAIR/ADDITlON(Prev. Sanitation Permit# _�`___--- -_- _.______ Date"�"_ __._____�_____________^_) + Septic Tank (Specify Requirements) _____________________ "� - � �- �� `.+' � ! Disposal Field (Specify Requirements) 1�H I I T� ----------- ---------r----------------------------- ------ -------------- -- ---------- -------------------- - - -- - --- ------ -- --- - ---------- ---------- ------------------------------ -- ' --------------- -------j-----------\--------------_- -------------- ----------------- (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 San Joaquin County.Ordinances, Stafe`Laws,�Ond Rules and Regulations of.the San Joaquin Locah-Health District. Home owner or licen- sed agents signature certif;es,,the{following: n .�ti )�It T ' 1-0 "I certify that in the perform nce of the work for which this perm is issued, I shall not employ any person in such manner as to become subject to Workman's..Compensation laws of California:" w s- r Signed ----- ----------------------------- -------- ---------------------- ---Owner f�e By -------- ---------- ------------------- -- --- Title ---------------------------- (If other than owner) FOR .DEPARTMENT USE ONLY 6--- G APPLICATION ACCEPTED BY / ,I>7�ru -Q.' ,�- -+--..DATE ------------ = ----•- ------- BUILDING PERMIT ISSUED --.-----__ /�jyy�y/y�/p( /jfy��♦JJ(f)) _ / "'"` - DATE ------------------------- -------------- ADDITIONAL COMMENTS' ------....(---------- - ----- --- -1----- --"L__L/ ------._:� `_- ------------------------- ---------- - - ---- ------------------------------ --- ---------------------- ------------------- --- - ------": - ,,-., , 1 1,,.. . "� ------ ---- - ------ ----------- ........_............ . . - ------------------ ... r_ -------------------------•--- ----�--- - - ------------- =------ -------------------------------------------------------------------------------- ---��{{ --- - ------•------------ Final Inspection by: -� '�------------------- -Date ---- -t4 ------ ------ ------ �"" ' SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M