72-241 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: -------- --- - - ----------------•---- APPLICATION FOR SANITATION PERMIT, ` Permit No. (Complete in Triplicate) ) " ------------- ---------------------------------- Or i Date Issued ------------------------------ This Permit Expires 'I Year From Date Issued r • Application.is hereby made'to the San Joaquin,Local Health_District for a permit to con3truct acid install the work herein described.'This application.is.maclb,in.compliance-with,Courii` Ordinance.N� 49 and ezlsting'Rules and Regulations: l -- f of JOB ADDRESS/LOCATION .--- _ -- -- --Q � CENSUS TRACT -----------------••---_--- Owner'sO ame -1 y L� - --- - Phone ----- Address J�l' I -----•------- City _4i+/ Gc, n r .r� ----------.License # �j-� '✓9/_�Pho a __ �C..7_ _ Contractor's Name ._--- g - �f�/p------ �/ Installationill serve: Residence Apartment House,' Commercial ❑Trailer Court/0 r Motel ❑ Other ------------ ---------t-------------- ,•._..... or Number of living units:--- ---____ Number of bedroomsV.. Garbage Grinder -- Lot Size I Private ❑ Water Supply: Public System and name Character of toil to a depth of 3 fees Sand❑ Silt❑ Clay Peat❑ Sandy Loam 0 Clay Loam_[] :,.Hardpan ❑ Adobe Fill Material _____ ) If yes,type ---------------�.__.__------ V (Plot plan,vkshowing 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,) O PACKAGE TREATMENT I ] SEPTIC TANK![ I Size-------------------------------------------;---f Liquid Depth -------------------------- Capacity = = Type -------------------- Material---------------------- Nor'Compartments ------•--------------- Distance to near E�" a t: Well ------------------------------------ --�- --- Prop. Line -------------------- ' ------ --•-•- -- Foundation _____________ _ - -•-•-If LEACHING LINE No. of Linest' ________________ Length of each line.--..e- ----------------- Total Length --�� ._.-----.-- D' Box ._---- ---:Type Filter Material �f _Depth Filter Material .. le" --- .... 41 110� Distance to nearest: Well ________________________ Foundation ---/-011 Property Line. t ------------- SEEPAGE PIT �Q` j; Depth �-�--�_---- Diameter-_ Number -----Z--_--_---��-_.--- Rock Filled Yes�r No ❑ ! Water Table IDepth ___ k -�>�-----------------�--_--•-•-•--,-Rock Size �-^--�-�;-•-• - - . _ i Distance to nearest: Well --___�_�---------------------Foundation ��e------- Prop. Line __ --__----.-_-___- REPAIR/ADDITION(Prev. Sanitation Permit# -------- ----------------------------------- Date ---------------_____--------------} Septic Tank (Specify Requirements) --------------------- ---- ------------ f } - ------- Dis Disposal Feld lS ecif Requirements) --/�- _ ----__-_ �f ___ _ _ . ---.- �---------�-- = /�--------------- P # Pr Y q cr5/' r -- ,o-vI-----�.s'l f �- --------------- -------- ----------------= -------- -------- ---------------------------------------- ---------- - (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 Son 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 --- -- ---- -------- - ------------------------ Owner --- -------------------- --- - ---- ------ By -------------------------- --t------------------------ Title �r�` (If r t an owner) f f FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - ----------------- ----------------------------- - ----------------------------- DATE ------ 7 7 0--------------- .. BUILDINGPERMIT ISSUED ---------------------- ---------------------------------------------- ----------------------------------DATE ---------------------- --------------- ADDITIONAL COMMENTS ------------------- 07 ----------------------------------------- - Date- ----------------------------------- Final Inspection by: ------------------------ -- ------------------ ---------------------------------------------- --------------- ------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1•'68 Rev. 5M t .