70-214 - Laserfiche WebLink

Home Browse Search

� 11 f, FOR OFFICE USE: fi i- ------- , l__ AP tAJ— ION FOR SANITATION PERMIT - r (Complete in Triplicate) Permit No70__-.�/_ _ r ________ This Permit Expires 1 Year From Date Issued Date Issued_'3l_-'_� F ? 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 existing Rules and Regulations: ` / CENSUS TRACT _Sr_7_______________ JOB ADDRESS/LOCATION �(?/.- C� ' Dt�---------------- --------- ---------------- -- r ` Owner's Name �- -�- U :tet -- -- if Phone . Address+ l �' _ G CitY� �`C ------------------ � Contractor's Name ----- -a_/ - -- - � --e)------------------------ License #` _/.. - Phonefl.s`�--b -- Installation will serve: Residence {Apartment House❑ Commercial❑Trailer Court Motel ❑Other r--------------------------- ---------------- - Number of living units----.-------- Number of bedrooms .2------Garbc�ge Grinder ____________ Lot Size -- Q " ------ 1` Water Supply: Public System and name ----------------------•------------------------------------• --•---------------------------------------Private j Character of soil to a depth of 3 feet: Sand'❑ Silt C] Clay ❑ Peat❑ Sandy Loam ,E] Clay Loam ❑ 1 Hardpan ❑ AdobeK Fill Material ------------ If yes,type ------ --------------------- (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,) PACKAGE TREATMENT SEPTIC TANK f Size__. -L. X d �— i 7 7 - Liquid Depth --------- Capacity _p_a-aaType _ __ Materiala+-t_-; __ QNa compartments �____�____:____ I Distance to nearest: Well --------- _ ...............Foundation Prop. Line ----4:5 LEACHING LINE No. of Lines __._.__ _ �d � f ) � -- Length of each line Total�nfgt h ---I---------------------• 'D' Box .-}/.--.--- Type Filter Material'�-��'.-_Depth Filter Material`�' --------------------------- I Distance to nearest: Well ----- ------ Foundation .../_Q-_f--------- Property Line. -s�________________ jSEEPAGE PIT ( ] Depth _____ Diameter ________________ Number ---------------------------- Rock Filled Yes ❑ No .0 Y ` Water Table Depth ------------------------------------------------Rock Size -------------------- E ---------_f=oundation -------------------- Prop. Line -------------------Distance #o nearest. Well ____________________________ __ � f REPAIR./ADDITION{Prev. Sanitation Permit# ____________________________________________ Date __________________________________) Septic Tank (Specify Requirements) ---- ----------------- ------------- --- - -------------------------------------------------------------------------------------------------- Disposal Field (Specify Requirements) ------------------- ------------- - ------------------------------------- ------------------------------------------------------------- --------------------------------------------- ------- I-------------------------------- --- --------.- -------------- ------------------------------- -------------------- ----------- -------------------------------------------------- (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, State Laws,and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- 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 f ----=---- --- --r--- -----------------------. Owner `- Y --- � BY -------- ---------- Title ------------------------------------ ----- --- --- - .. ------------- (If other than owner). FOR DEPARTMENT USE ONLY APPLICATION AECEPTED BY_- ---- --• DATE _3-31-70----------------------- ---------------- BUILDING PERMIT ISSUED -------- tom/ ----- ------ ---------- ATE ADDITIONAL COMMENTS ---- f --- - - -------------------------------- --------------------------- --------------------- ------------ ------------------------------------- -------------W- -------- ------------------------------- ----- - 1. ,.. Final Inspection by: \ - Date - '. - Y SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'6� Rev. 5M "