70-509 - Laserfiche WebLink

Home Browse Search

<< FOR.OFFICE'USS "� APIPLICATIOIV FOS SAWITA�r6I��ERMIT -- ---- ----; --- Permit No. ------- ",. -`""(Complete in Triplicate) z ----- --------- `J Date Issued --- -r---------Jy] y y 1��I This Permit Expires 1 Year From Hate Issued Application is }iereby made o'the San Joaquin Local Health District for a permit to construct and install the work herein _ . Regulations- described. This application .ts made in compliance with County Ordinance No 549 and existiriyg,+Rules and Regula#ions: It J09-ADDRESS/LOCA !-STH- © ----------------CENSUS TRACT ---S-5- -------- Owner's Name ----- -------L------ ----------------- ------------------ on ------------------- ------------- Phone 7 _ - - 1--' Address ------------2'767------�------�TH-904- -----• City - -----------. : Contractor's Name ----- ----------------- ------License # ---- --- : Phone Installation will serve: Residence Apartment House] Commercial ❑Trailet Court ;[]• Motel ❑Other -------------- ------ ----------------- -- Number of living units:________-__Number of bedrooms -"Z-- ---Garbage Grinder Nt?--- Lot Size ____ t Y y Peat Sand Loam -------------•---------Private [ � Water Supply: Public System and name --- =-��__�!�_�:'"#---------------{------- --------------- ----------------- ----- Character of soil to a depth of 3tfeet. _Sand❑ Silt❑ Cl ay ❑ ❑ y Clay Loam ❑ + -_ — _ _ A � ' Hardpan ❑ Adobe-❑ Fill Material -WO-" �V O- If yes, type ---._______________________ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) ll\ NEW INSTALLATION: {No septic tank or seepage pit pLrmitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ } SEPTIC TANK![ I Size------------------------------------- --- -- -- Liquid Depth -------------------------- Ca acit _ Ty e -------_.------ --- Material---------------------- No. Compartments ---------------------- s Distance to nearest: We I ------------------------ ---- ---- Foundation -- ------------------- Prop. Line __.------------------- .. LEACHING L1N6 '/�[:.}- No. of Lines ----------------- - ---- Length.of each .line------_------.------ Tota! Length .-------.-----------....----- : '11 -. '1 vim. � + Depth Filter -Material ------------------------------- ------------ 'D' Box ------------ Type Fi.lt r Material_..----- ---------- p Distance to nearest: Well ------------------------ Foundation --------------- -------- Property Line ------------------------ 1 Rock Filled Yes No SEEPAGE PIT ] Depth -------------------- Dia eter ---------------- Number ------- ------------ ----- ❑ Water Table Depth / -------------- '!`�Rock Size 4 I At Distance to nearest. We . ___x_____ ._Foundation __ _________________ Prop. Line ___.______.-----____-- --------- - ! REPAIR/ADDITION(Prev. Sanitation Pernriit#..-------- _ --____-- -Date ____--______ } + Septic Tank (Specify Requirements) = 4 ti-------------- - Disposal Field�(Speci.fy-PRequirements) ----- � oYF -----------++ 8't t --------------------------------------------------•--------- ------------------------ ---------------------------- - =------------------------------------------------------------ ----- (Draw existing and required addition fon reverse side) I hereby certify that I have prepared this application and that the worlt'will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the SanJoaquin Lacal Health District. Home owner or licen- sed agents signature cei�ifies the following: "I certify that in the performance of the work for which this permit is Ilued, I shall not employ any Person in such manner as to beco subiect to Workma 's Compensation lows of California." Sig `--------- - -------------------------- Owner Title._ --------------------- B _ ---- y r (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED 'BY ._* i d'--------------------------- -------------------------------------------- DATE -------7- ---------- BUILDING..PERMIT-ISSUED.---------------------------- - --------------------------------- ,---;-----------�-•--fi--i--i--S----=--Fi--- -------------- ------------------DATE ------------------------------ ' =� = -ADDITIONAL COMMENTS ------- ------------------------:, -== A -a ---------_--------------------------_--------_------------------------------------------------------- _________________________ --', f- -�- ----- --------------- --------- - --- Final Inspection b ------- ----- SAN JOAQUIN LOCAL HEALTH DISTRICT G t E. H. 9 1-'68 Rev. 5M