70-585 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE. 1 �3v APPLICATION FOR SANITATION PERMIT /- ------------ ------ Permit No. _7o, Q ------------ ------- (Complete in Triplicate) - t --------- ---- --------------_--_---___.____ ._._________--.__________ This Permit Expires 1 Year From Date Issued Date Issued 6-.7C7 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 Rules and Regulations: ('70 /v E-r= .4✓ / JOB ADDRESS/LOCA ION / 4--�- -- _ -- r- --�----1.I�- - ---------------CENSUS TRACT Owner's Name �;----------Phone -----------_-_�-_-o---3-------_z-----------�- y Address _- - � -------------------- ----------- ----- --4----------------------------------------------------•------ Contractor's Name Q --------------------------------------------License # 6�_ -1 Phone Installation will serve: Residencepartment House ❑ Commercial ❑Trailer Court ',❑ Motel ❑Other Number of living units:_.__----- Number of bedrooms __-_Garbage Grinder _ Lot Size /249-,)c-- d__-___-__-_ Water Supply: Public System and name ---------------------------------------------------------- ------Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat F1 Sandy Loam -❑ Clay Loam ❑ Hardpan E] Adobe Fill Material .X)// 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 jze_ ----------------- Ligyidepth �________ �Q� !' Capacity _.__ Typ --. a_r_S7A/Material Comp Comp rtments _`__�r— �� ---------- to nearest: Well _fi____-___________________Founda�on _____._-,__-________- op. Line ___15___—---------- Distance LEACHING LINE No. of Lines -_saw__---------------- Length of evh line_ , - '��.�___ Total Lengthr1�_+�_____--____-_-- D` Box __i�/ � Type Filter Material __ -1_Agepth Filter Material _ Distance o nearest: Well ----so__"-------- Foundation 1d___1------------ Property,Line ______________ SEEPAGE PIT Depths---------- Diameter.3-_-_ ---- Number ---__._______ Rock FlllAd Yes Flo I[� pp ` fi Water Table Depth t�_ J ----------Rock Size -{-12- Distance to nearest: Well ----- D_________-c.------------Foundation _r------ Prop. Line __.___F�______:__ REPAIRJADDITION(Prev. Sanitation Permit# ------------------------- ------- Date ________________----_-__-_________} Septic Tank (Specify Requirements) ----------------------------------------------------------------------------------- ----------------------=----------- =-------------------- Disposal Field (Specify Requirements) -------------------------------------------------------------------------------------------------------------- ;-------------------- {} --------------------- --------- -------------------- - --------------------- -- ----------------------------------------- ------------------------ -----_-----------------------------_----------------------------------------------------------------------__------.._----__--_______________-_--______________,__--__________________--__--______.__._____ (Draw existing and required addition on reverse side) I hereby certify that 1 have prepared this application and that the work will beMone 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 certifie's the'follotving: , fl i "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 Compen laws of California." Signed - .A _ . _ . _ .O---------------- ....--- wne r BY ---------------------- - �ZZ• F - --------------- --------------- Title _ ---- ----------- oth t an owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- o Q ----------------- DATE --- - -- -- ------- BUILDING PERMIT ISSUED ------ -- ---- ' = - ---DATE ------------------------------------------- ADDITIONALCOMMENTS ---------------------------------------- -------------------------------------------------------------=----------- ----- -- - - ------------ -------------------- ----------------------- ` ------- ----------- ------------�-------��------�------�-------f- --- - ------------- ------------------ -------------- ------ ------ ----- ---- - - ------------ Final ------ ---- Final Inspection by:- A_ ------ ` ----------Date ---- .-1g--------D------- -------- --- ---- - -------- ------- -- - - -------------------- -- SAN JOAQUIN. LOCAL HEALTH DISTRICT w r � • ,� -tf + i � E. H. 9 1-'68 Rev. 5M