70-785 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: AP `off. 9j f, V PLICATION FOR SANITATION PERMIT ------------------'------ -------------------------------- f --7 (Complete in Triplicate) Permit No... , ------------------------------------- This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the Son Joaquin Local Health Di ric44-e permit to construct and install the work herein described. This application is mad am i e No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION .Jx w --- --- ,r ?�1 -- 0-�-�/'.L19 - s-------CENSUS TRACT ------------------#------ --- Owner's Name /J_.l�Tt�,l��`-------�-U.1"U'09 ---------------------------------------------------------Phone ------------------------------------ Address ---- ----- -----•------------------ Address 1 4,,i ------------------ ---;'- --. city, ---�aIr ---------------------------------- Contractor Name --y� - •-----s . fJr `� '.--_c�. ��--------------------License # - -7 __.Phone /� -Ci^v �- Installation will serve: Residence Apartment House❑ Commercial :[]Trailer Court Motel ❑Other ----- , Number of living units:-__ Number of bedrooms __3_._,.Garbcge Grinder _JV0_;Lot Size __, A<Rr ��__-__:___$______ f Water Supply: Public System and name -------------------------------------------------------------------- Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam-E] Hardpan Adobe ❑ Fill Material '--- a---- If yes, type ---------------------------- r (Plot plan, 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 sewer is available within 200 feet,) r 41 -- PACKAGE TREATMENT -- ( ] SEPTIC TANK�f Size___�__..f�___.J_f_,�'x�___.___ .__.____' Liquid Depth _ ____ �t ---------------- Capacity _/"4?60Vfype Material��;V No. Compartments ____________ _________ ffV1 Distance to nearest: Well .......rie_f___________________Foundation __!O ----- ---- Prop. Line LEACHING LINE I] No, of Lines __-�_______________ Length of each length _-Fe)0_r_________ Y p P J/ D' $ox'/ •Mnteriia1 '----- T e Fitter Material /PC7_C%____De th Fllter' _____ Foundation /�. P l l Distance to nearest: Well --��_ _-- - __-- _-- _-. �-::•__-:: Property Line �---------------- SEEPAGE PIT Depth ,Diameter aNumber _____r ' lttck Filled Yes No x Water Table Depth -Ag-19-a-1 -----=Rock Size 4 Distance to nearest: Well ----f0.Q--------------------------Foundation -1a_ -i--+--- Prop. Line __,f.....---<:..... REPAIR/ADDITION(Prev. Sanitation Permit# ------- ----------------------------------- Date ------------_---------------------I r Septic Tank (Specify Requirements) ' - ---------------- Disposal Field (Specify Requirements) __________________ ) f ! e I I -'------------------------------- -------------------------------'--------- ky'---�=------------------------'- (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 acco�dancb"with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed icen sed agents signature certifies the following: "1 certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner J as to become subject to Workman's Compensation laws of California." - Signed -------- Owner ' Sy - ------------- ------------.-------------------- ----------------------- Title. ---- -------- -. -------------------------------------------- � (If of r than owner) \ 1 POR DEPARTMENT USE ONLY r APPLICATION ACCEPTED BY bA7E tG , BUILDINGPERMIT ISSUED ------------- ------------------------------------------------•------------ ---------------------------DATE ------------- ----------------------------- u ADDITIONAL COMMENTS -- ------------- ----------------------------------- ----------------------------------------------- = ---------------------------------------------- ---------------------------------------------------------------------------------------------- -------- ----- j f --- - ------=------ Final Inspection by: ------------------------------------------------------------- Date � SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M, -0