68-423 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SAtI ITATION PERMIT &g_lfa 3 -- �� - - .�...-•-.I Permit No- --------------------- (Complete in Triplicate ------------------ -------------- =iI 4 s-� �� J� Date Issued "-'""".. _e This Permit Expires 1 Year,From Date Issued Application is hereby mad -------------- ---------- I pp y e 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 Ordindnce No. 549 and existing Rules and Regulations: JOB ADDRESS/LOC ION�47--�/----- llfl-, = ----------------- -----CENSUS TRACT --------------•---------- =`6` (- hone ---------------------•-------------- Owner's Name Address ------ � == _`` :_- . -City '1L---------------------------------------c�- k r !. ------License # �/D% --- Phone Contractor's Name "" i -- - ---- � ---- --- �I � Installation will serve: Residence E-]Apartment House CommercialTrailer Court ❑ Motel ❑ Other ---------------------f ------------- ------- ------------ ----- Number of living units. -------- Number of bedrooms -"-4___"""_Garda�g-e Grin�d�e�r Lot Size " Water Supply: PublicSystem and name Lt�C" � 4�-� �1 - a - '` J"-""---- -Private ❑ Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay [j Peat[:],r Sandy Loam ❑ Clay Loa m;❑t Hardpan E] 'Adobe Fill Miaterial -If yes,type V"" .---- `-_ ------- �i i •�' � . [Plot plan, showing size sof lot, location of system in relation, to'wells, buildings, etc. must be placed .on reverse side.) \ i .el f NEW INSTALLATION: (No septic tank or seepage pit permitterd"if public sewer is available within 200 feet;) PACKAGE TREATMENT [��] SEPTIC TANK "" -.`•�~ - - ------------- Liquid Depth f ? - --------------- G p T e ------------ `Mate`rialr No. Compartments = 21. Capacity �-7 --`---.- -- YP .. f "•",..1.."`` `-�vf Distance to nearest: Well ____ - ------------------fFoundatioUn " Prop. Lire' "_""�---- INE No. of Lines Len each lme �r Q Total FLength`y f ......--- LEACHING L it cZ------- 9� . eya.�..� "Le Pa ---- T [.r� Depth Filter Material ----�C -.----•------------------ it r;'.� � V� �, .., „". v r D' Box - e Filter Ma "" r Foundation �Re Property Line----� �- Distance to nearest: Well —° - T Rock,�Fil led Yes No i Number = =^ SEEPAGE PIT Watch Table Depth ��- eter """µ Rock Size _ "_- ------------- -� ��Z� Distance to nearest. Well -+ "_.� ------"_"_--Foundation IR-12-1------ Prop. Line -""_"___"_" "- i REPAIR/ADDITION(Prev. Sanitation Permit�# -.-"---- -------------------- � Rate __"""""""."_" ) Septic Tank (Specify Requirements) --------------- I Disposal Field (Specify Requirements) ----------- -I ------------------------------------ ` 1N. --------------------------------------- ---------- 11 � (Draw existing and required addition on reverse side) I hereby certify that'll hive 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, 1 shall not employ any person in such manner kas to become subject to `Workman's Compensation laws of Califci,rnia." Signed ------------------ I! - ---------- '- Owner 1-------- '�- By Title ---- -- ---- (If other than owner) r I� II''__ FOR .DEPARTMENTi USE ONLY APPLICATION ACCEPTED BY --------11-0----------�----------------------- �t----------------------------------------- DATE "" �3 -------------------- BUILDINGPERMIT ISSUED --------------------------------------------------------------€-------------------------------------------DATE ---------:------------------------------- ADDITIONAL COMMENTS ------------------------------ p ------------------ -------------------------------- M ---------------------------�------ W In - io --- - --- ------------------------------- ----------------- --- Final Inspection by� -------�� - �•--- ----------------------------------------- --- -------------- -----�M--- ------------------ -------------- .Date �p3 -------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 i 1-'68 Rev. 5M 4`,