74-459 - Laserfiche WebLink

Home Browse Search

r'OR OFFICE USE: APPLICATION FOR SANITATION PERMIT --•..............:.... - Permit ........ ............. _ ,.....,.... . . (Complete in Triplicate) � _ / ............................ Date Issuec!5__�L".� .. This Permit Expires I Year From Date Issued 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 Couniy�Ord!nonce Na: 549 and existing Rules and Regulations: -3 108 ADDRESS/LOCATION ,... _ ._ .-./..4.-46'lYY ..1��. ..._...........................CENSUS TRACT .,.. J P !1 .. ... .........................:...... Phone ......... .� X69 Owner's Name �•— ��• - Address ............... �` -''�--� --- PAY Y .......... City ._. �G:S.. e or✓.. � *- J.. ... Contractor's Name _.. �eVr g ey y - _ Pd .._. -•---------.License #1� ,�� 6_... Phone a��....................•.... 3 I • Installation will serve: Residence.❑Apartment House Commercial QTra#ler Court 0 ' r Motel ❑Other ... `�.... :.. � Number of living units------------- Number of bedrooms ............Garbage Grinder _._._.__.... Lot Size ....____. hlcyes....___._ ......_..._._............ k F Water Supply: Public System and name ----------------------------.........-.............................................----•......................Private'. Character of soil-to a depth of Veet:,- Sand 0__Sllt-E] - Clay=Q:=Peot-Q --Sandy_Loam_� ClayLoom-0: � Hardpan E] Adobe.Q 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 seep a pit permitted if public sewer is available within 200 feet,) I / ,- / f � ,a'S .i' 9 Liquid Depth _.... PACKAGE TREATMENT [ ] SEPTIC TANK Size------ ------ ------------------------ ,.,i. �,7OC? p 5 6!9f Material .... No. Compartments ...................... Ca city TYPe T- .. . � istance r to nearest: Well IgA Foundation .�0 Prop. Line _____�.............. r LEACHING LINE No. of Lines A__.--------- Length of each line--.----��..r.........•. Total Length ......................Type a,,,.Distance to nearest: Well ._...�a�.�...... Foundation ..�5.............. Property Line ..... ..........._...... SEEPAGE PIT [ ) ..Depth Diameter ---•--•-._..._.. Number ............................ Rock Filled Yes ❑ Na lQ WaterTable Depth --------•---•-•-----••--••----•.................Rock Size ................................. Distance to nearest: Well.................... ..............Foundation ......._.-__.. ..... Prop. Line --_--------_---- � i? REPAIR/ADDITION{Prev. Sanitation Permit# .......................... Date .................................. Septic Tank (Specify Requirements) ..-•----...-_.--••-_----••--•------------------------------•--.....------............------.............. _......... - P" 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 j 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 nsanrter as`to become subject to Workman's Compensation laws of California.". Signed . . ',, ,�4w T1 olY _-7c... ................................ Owner <. Tit11104 ;R, le,oolio ;101le ... ........................... (If other an her) 4 . , FOR DEPARTMENT USE ONLY _ _ - DATE '� APPLICATION ACCEPTED BY 4 ;z ......D TE BUILDING PERMIT ISSUED ...............f.._; .. ... -•••..:........_ -• ••_. ADDITIONAL COMMENTS ........ .........r._-.....,: - - = ;,..-----....-----....--•---..............__....•............ .........................•------. --•-_.._. ......-- --• .....••---......--•• ---- ....... ---•- —... -----`--•- Final inspection y --.. ._..:. . Date �1.. �1.: �ySAN JOAQUIN AOCAL' HEALTH DISTRICT - 7/72