70-590 - Laserfiche WebLink

Home Browse Search

r. a FC?!2 OFFICE ISE: - 4 APPLICATION FOR SANITATION PERMIT ----- - Permit No- ------------ ' (Complete in Triplicate) ------------------------------------------------- This Permit Expires 1 Year From Date Issued 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 complian e with County Ordinance No 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION L`J _ _ _ _ _� � _ _ _<� _-_, ?'e__CENSUS TRACT ____ `7.�_______ Owner's Name Ca- L'-r-- Z- Phone._ ------------------ Address r -/-�-- Address `! ' --- City --VklSs--------- ---- -----------------------------------� Contractor's Name ----- License # - Phone Installation will serve: Residence Apartment House❑ Commercial ❑Trailer Court 0 Motel ❑ Other -------------------------------------------- Number of living units------l------ Number of bedrooms ----2--__Garbage Grinder __-__'__,j--Lot Size ----- _.__________-_.--_ Water Supply: Public System and name _________________l= - y--Y---- _ _--.---_ ___-___-_Private (x - - =' Character of soil to a depth of 3 feet: Sand'❑ Clay ❑ Peat E] Sandy Loam [] Clay Loamm Hardpan Adobe ❑ Fill Material ------------ If yes, type ---------------------------- r (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,) v / / PACKAGE TREATMENT [ ] SEPTIC TANK fr, Size___0.,--_-:XlP----X-�'..._..__. Liquid Depth ---ti'Z_-___-_--_____-__- Ca ------------------ Capacity Q� -------- - No. Compartments _ p Y��i�""------ Type ..l�c_�_ Material_4�� ---------------- f r I 'stance to nearest: Well e-------------------- __��---. ------- Prop. Line ___ -________.____.__ LEACHING LINE [/�o. of Lines ------- 1_------------ Length of each line----- r g - _ -�?_ Total Length ..- ------��-- 'D' Box -----------_ Type Filter Material l -_1Cepth Fitter Material 2_____________________________________ Distance to nearest: Well ------------- Foundation ---A7--------------- Property Line. ------------------------ r ] SEEPAGE PIT Depth _� ______________ Diameter -- Number _.._.----._-f ------------ Rock Filled Yes JX No I❑ Water Table Depth -------V0 Rock Size / f / Distance to nearest: Well ---f ��________________________Foundation -le----------- Prop. Line ___�� .......... REPAIR/ADDITION(Prev. Sanitation Permit# ------.------------------------------------- Date __________________-________-_____) Septic Tank (Specify Requirements) ---------------- ;-_ -s ------- -: --------------------------------- ------•------------------------------------ --------------------- Disposal Field ,Spscify Requirements) "TSI M �I ._ / -Dv1_S _a____Ti'�1r}T�--.--.f��- �_l�_._____-I_�-_S-----_ t j-R E. L - ► ' P--n 56715 l 1�Vi4 S /iY T L0—= :---O-Wn-----T3iS PntDcr(C— PP1L- " `FPPRGt_i[d � 'h-cam. �.. (Draw existing and required addition on reverse side) I hereby certify that -1 have 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: `, A. _ "1 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 ----- ------ ----- f Owner ---------------------------------------------------- 6LW- BY Title =-------------- - --------------- (if other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---�-I-1�_ A ---'------------------------s-- ---- ------ -------------- DATE ---- = 4 BUILDING`PERMIT ISSUED -------------------- - ------------------ - " _- ----- D T ADDITIONAL COMMENTS -- -- - -------------------------- -/-I------------------------------------------- -------------------------------- --------------------------- -------------- -- ------ --- - - -------- - -- --------- ------------------------------------------ ----------- --------------- -------- - - -- ------- -- ---- ---- -------------------------------------------------- Final Inspe : __ -----------------------.Date ------ SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M