71-567 - Laserfiche WebLink

Home Browse Search

<' V% FOR OFFICE USE: APPLICATIONL,,FQR-"SA1,4ITATION PERMIT - q r� Permit No. -f-�-^`��l- (Complete in Triplicate) --------------------------------- - This Permit Expires 1 Year From Date Issued Date Issued / 7Z ZoI — 200r1fo - Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application-fisamad i.,compliame_with County Ordinance No. 549 and existing Rules and Regulations. jJO ADDRESS/LOCATION ___-L _,__�YP-Ill2 Y ---±►.16_5i . /`&ENSU1S TRACT _-___-�-�_...-_. �p Owner's Name -------- -----7, --------------------------------------------------- ------Phone r Address --- ¢ �� ' _f ---------------------------------------------------------- City ----).PP�_Al.---------- --------------• ---.-.-----'..g--••----- Contractor's Name ___.__.._ !_ l�c� _ r__/�'! - � __________________License # S'S.Z y�-__ Phone _!1_:L -S7!Y7 Installation will serve: Residence [--9p-artment House�❑ Commercial []Trailer Court i❑ Motel ❑Other -------------------------------------------- Number of living units------------- Number of bedrooms ----- _---Garbage Grinder ------------ Lot Size Water Supply: Public System and name ---cpl --- 111(1) -L�---- - - - -----------------------------------Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam Hardpan ❑ Adobe 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[ ] Size---10', ---------------------- Liquid Depth -- --------------,----- Capacity I&OICY----,-- Typeo?�_a --- Material s- No. Compartments __-_-_------ ---_- Distance to nearest. Well -----t7p0--e--------- ---------Foundation __1A--------------- Prop. Line ----I ..:.._-..__ LEACHING LINE [ ] No. of Lines ---------3------------ Length of each line------9d-------------- Total Length -____,.�_2�P........... 4 -' 'D' Box _ _ z- Type Filter Material10-r-44-4-DepthFilter Material ----------- - ---r___-_ Distant to nearest: Well ----3'sFoundation -----/0------------ Property Line --_- ............... SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No 13 Water Table Depth ------------------------------------------------Rock Size -------------------------------- Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ----------- .......... REPAIR/ADDITION(Prev. Sanitation Permit# ____--_ -------------------------- Date _--________________________--__._-] SepticTank (Specify Requirements) -------- ----------------------------------------------------------------------------------------------------------------------- ----------- Disposal Field (Specify Requirements) ---------.- ---------------------------------------------------------------------------------------= ------ ----------------------------------------------------------------------------------------- ---------- ---------------------------------------------------------------------------------------------------- --------------------- -----------------------------------------------------------------------------------------------------------------------------;----------- (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 i County Ordinances, State Laws, and Rules and Regulations of the Son 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 becomesubjectsubject to Workman's Compensation laws of California." Signed - !! T --r---------------------------- Owner By --- Title _.. ----- ------------------------------------------------------ - - - -------------------------------- (If other than owner) FOR DEPARTMENT U LY APPLICATION ACCEPTED BY -------------------- -------- -- ------------ ------ DATE _44-7)------------------------- BUILDING PERMIT ISSUED ------------------------- DATE -------------.--.__-------- - - -- - ---------------- ADDITIONALCOMMENTS .----------------------------------------------------------------------------- --------------------------------------------=----------•----------:----- ------------------------------------------------------------------------------------------------------------------------------------------------- ------ --- -- --------- - ----------------------------------------------------------------------------------------------------i-------------------------- - - ----------- - i Final Inspection by: -------------------------------------------------------------------------------------------- ---Date �J------------------------- a_�� ------ t SAN JOAQUIN LOCAL HEALTH RICT E. H. 9 1-'68 Rev. 5M G