71-419 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR S1NIATION, PERMITPermit No. 7/ : .� Sr�,-n I ]l+30__.x_""_-� ----- (Compiete in Triplicate) ----------------- Date Issued _ ._r this Permit Expires 1 Year From Date Issue ------------------------------------- with County Ordinance No. 549 and existing Rules and Regulations: Application is hereby made to the San Joaquin cal Health District for a permit to construct and install the war herein p application is madelI,n compliance described. This app I -------CENSUS TRACT --------- I � - !OB ADDRESS/LOCATION ----- � - -_- ----Phone --------- ----- -----------------"-- -- Owner's Name city ft --- -- ----------- Address _. R �, Phone �f '� License #� .� Contractor's Name -- - "" Installation will serve: Residence partment House'❑ Commercial ❑Trailer Court ',❑ Motel ❑Other -------------------------------------------- Lot ---- ------ ---------------- --- -- ----- { - --Gam ` Number of living units:---/------ NuI ber of bedrooms --t/----Garbage Grinder ---�1-- Lot Size /----------------------- """_____"Private � ~Sand Loa Water Supply: Public System and name -----------------------------------'- - "" -!""" "" -�-- ❑ Clay Loam:0 } ' m f Silt❑ Clay .❑ ,r Peat❑ Y � - Character of soil to a depth of 3 feet: Sand'Q - I Hardpan ❑ Adobe Fill Material if Yes,ty:p ---------------------------- Hardpan -- --------- -- y IV size of lot, location of system do relation to ell'i, buildings, etc. must,-be;placed on reverse side.] (Plot plan; showing P _ . i P � it �ermitfied�if public sewer available within 200 feet,) � E NEW TALLATION:�(Na'se ti nk o� see age p p ----- Liquid Depth� ----------- PACKAGE TREATMENT [ ] Size_" _- - I SEPTIC TANK' ,�L ' '` Mafierialf7,�%`�</��No. Compartments "1��--"--"-• CapacitYl �� .01 TYp �° -- -----_----Foundafiion Prop. Liner�-��----• Distance to nearest: We11 -__4 -: —f Total Length -� ----------- No. ---•---- No. of Lines _. _ Length of each line- �� e� ING LINE "" _" I r- _ " T e Filter Mater I�' �,p1f�Depth Filter Material � --------------------------------------- LEACH, '. No .. D' Box �� Yp Foundation _ ---� Property Line. r Distan a to..near rest:-Well req----------- a l /j ` Rock Filled Yes 0 ------ Number :""-- SEEPAGE PIT [y)' .Depth C2. _ Diameter��d �----------------- !i s _ r` Rock Size -� 4t_ ------�------- -- _ l Water Table Depth - --- - ---- Pro ._�----- -------- ' _"_"•". Foundation .!�i��--- p• Line I Distance to nearest: Well_ - Date ------------------•------- REPAIR/ADDITION(Prev. Sanitation Permit r# -------------------- - --------------------- ecif` Requirements) ------------------------------------------------------------------- ------------------------------ Septic Tank (Specify q ------------------------------------------------------------ Disposal Field (Specify Requirements ""_.-------- -.""""s-�,� --------------------------------------------------------- ------------ -------- ---- - --- -"--""- ----"" " - (Draw existing and required addition on reverse side) wi ith Son 1 hereby certify that 1 have prepared this ap County Ordinances,'State Laws,'and Rules and Regulations of the San Joaquin Local oHHealth Distrctne in accornHomeownef or Icen Iplication and that sed agents signature certifies the following: erson in such manner "I certify that in the performance of the work for which this permit is issued, I shall not employ any p as to become subject to Workman's Compensation Haws of California." -- Owner Signed --------- ------- -- ...... ----- ------------------------- - 11 i itle _ -"-- , BY -------- -------------- -,. - (If oth an owner • - r FOR DEPARTMENT USE `ONLY DATE ----------�j--- I ------ ----------- APPLICATION ACCEPTED BY ----------------------------------- -------------- DATE ------------- ------------ ----------- -- --------- -- ----- ------ ------ ------ ----- - - P--E--R--M---IT- -ISSUED - - ---- -----------------------------------` --- --- ----�---------- - ------------ ----------------------------------------- BUILDING ONAL CO�E S _ ` " - ------- ---• --------------------- A---D�DI ,�---- -- --- ------ ------- -------------------- -- __ __ _ __ __ __ ---- � _�_��'-------------------- ---------- ---------------------- � -------------- _Date ,-- --1 -- -------------------- ------ - --- ----- ------ Final Inspection b "- ---- --------------" -----""" ---- \iyw p Y° ----- SAN lOAQUI AL HEALTH DISTRICT T `�, .'tip z u 0 _'AR Rev. 5M