70-21 - Laserfiche WebLink

Home Browse Search

i II FOR OFFICE USE: jU APPLICATION FOR SANITATION PERMIT `� Permit No: , I` (Complete in Triplicate) -- I k ------------------ _------------------------ ----- This Permit Expires 1 Year From Date Issued Dote issued Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and exis in Rules and Regulations: l DRESS/LOCATION.-----------Q - ------ RACT ----------------------_-- - ---------- -- Owner's - --------..__Ph ne.113�---6333---- J B A r i Name ' -------- ------ - ` ------------------------------------ - City ------------------------------------------------------------- I - ---------•------------------------------------------- Contract --------------------------•License # sxn;s1/------ Phone ___� or s Name -----------�:�(��,�P---- �. cess Installation will serve: Residence ❑Apartment House❑ Commercial f:]Trailer Court !❑ Motel ❑Other ------------------------------------ -- Numbed of living units:... Number f. bedrooms _3 G6nder______L-1/ Lot Size ----- _ __ ___ _ _ Water Supply: Public System and name -- ------ ---------- --- -I ------------ ----- Private Character of soil to a depth of 3 feet: Sand'❑ Silt j] Clay ❑ Peat❑ 5a`nn ly Loam ❑ Clay Loam itHardpan E] Adobe ❑ 'Fill Material _ ___ If-yes,type ____________________________ (Plot p["n','-showing size of lot, location of system in relation to wells—, buildings;etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or, seepage pit permitted if public se� er is available within 200 feet,) T,\A r t PACKAGE TREATMENT { �] SEPTIC TANK'{ w / Size _. _J_y Liquid Depth �l �+" � I �- c..... No. Compartments Z Capacity _f&-C��-- -- TYP� -- - -�- �---- Material�. ------ � p -------------•-------- I ) -Foundation ----____ Pro Line __-_'__1_____________ 'I Distance to nearst: .Well t_____��_._�.____�______ l � � -- p. � LEACHING LINE No. of Lines ----- _ On th of c line_ ____cS�1-------------- Total Length -_;77l---_______-- i 'R' Box ----- - Typ&h;e�QMatericl - ----- -.---D4th Filter Material ---- ----- ---------------------•------ ¢# _ undatin �� Property Line Distance to nearest;Well __ _ SEEPAGE PIT [ J Depth -------------------- Diameter --------------- umber --------------------------- Rock Filled Yes ❑ No I❑ II � - + Water Table Depth ------------------------------------------'-----Rock Size -------------------------------- � III i i1 Distance to nearest: Well ----------------------- --K�-_l_....Foundation -_------------------ Prop. Line ------------ - -----. REPAIR)ADDITION(Prev. Sanitatlon Permit# ________________________________________ _ Date,_. _ __-_____-____-----) .a1 .I� 1 Septle Tank (Specify Requirements) --------- ------------------------------------------- ------------------------ ------------------------------ ---•-- Dispoisal Field (Specify) Requirements) ------------ ----------------- --------------------------------------------- ------------- - I ------------ ------------------------ ----------------- --------- --------------------------------I --------- ---- ---------------- --- ---------- --- Draw existing---and re aired addition on reverse sid ,^ � J ' 4 t r: I hereby certify that I ha a prepared this application anJ that the work will be d ne in accord'ce withh`5ctn``Joaquin County (Ordinances, Statel�Laws, and Rules and Regulations of the San Joaquin Local lHealth District. Home.ownerrlicen- sed agents signature certifies the 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." Signed J--------------------------- I�' , Owner + r B _ Title -------------------------------------------- (I�otn owner) FOR DEPARTMENT USE ONLY � I r .� + APPLICATION ACCEPTEDr��B�(, _--- ---- ---------------- ------------- DATE..,W1� '- �._- ------------_----- BUILDI G PERMIT ADDITIONAL COMMENTS---- - -------------------------------------------------- ------------ ----- __--- ----DATE------------------ -- • ------------------ -iM ---------------------------------------------------------------------------------------------------"--------------------------------------------------------- ---- ------I-------------"---._ 'I -------------------------------- s -- ----- ----------- -------------- ------------------------------- ' = ------------------------------------------Date ---------- -- ----------- -- Final Inspection by: SAN JOAQUIN LOCAL HEALTH DISTRICTf E. H. 9 1-'68 Rev. 5M