70-212 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMITS'\ <4.r %% permit No. ' {Complete in Triplicate) w i 1 - s�^> t - ------------------- Date issued This Permit Expires 1 Year,Frani Date Issued * --------�----------------- --------------- / Application is her made to the'San Joaquin Local Health District fora permit to eanstruct and install the work herein described. This application is m= in compliance with County Ord�ance No. 5 n d exiting Rules and Regulations: -- CENSUS TRACT -------------------------- JOB ADDRESS/LCATION 1 - � �� ► � - f----- Phone -- --- p ; Owner's Name .. ��'a� S 1 Address ------ ce------------------------------ - ._ City --- ��__=�_ klLicense ' �� _"" Phone-" -_- - Contractor's Name -------- -------- Installation will serve: Residence Apartment House'[] Commercial ❑Trailer Cour E-1 Motel ❑Other --------------- � ------------ Number f Number of living units:.--/--_-. Number of bedrooms :Garb�ge Grinder --_✓_"- Lot Size / /r -----•-- 4- '---------------------- --------------III Private Water Supply: Public System and name ----------------------•------- .d.. P Y I l Clay Peat❑ Sandy Loam ❑ Clay Loam ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt 1] Y'❑ , - r _#. - If es, 1... e ----- -- Hardppn ❑ , Adobe� Fill Mates ial _"-- - Y t�Y,+P 1" Ian showing size of lot, location of system in relation�to,#wells, buildings, etc. m st be paced on reverse side.) W (Plot p g ri.,, 1. II. NEW INSTALLATION: {No septic tank or seepage pit permitted if kpublic�s61ir ' available within 200 feet,) SEPTIC TANK j ] Size Liquid'Depth --------------------------- Ut PACKAGE TREATMENT [ ] . Ca acit Type Material" --------- No. Compartments ----------------- Capacity --------- -:.-•. P Y,`/--- Distance to nearest: Well _-""_"—.____ rl Foundation - -------------------- Prop. Line ---------------------- i _ Len` #h of, each_Line)" _"-- Total Length :----------------------•-•-- No.f"of Lines LEACHING LINE [ } g --�, --------------------------- " `D' Box ----------- Type Filter Material t---.-.-_�-----------Depth Filter Material ----- )------------•------ "� Fou at on Property Line. --------- -------------- ------------------------ Distance to nearest: Well ------------------ Na i❑ Depth I- Diameter ---------------- Number ---------------------- hock filled Yes ❑ SEEPAGE PIT [ ] P — Water Table-Depth --- - Rock=Size ---------------------- D,lstanc o nearest: Well --------------------------- - •.-Foundation ------------------- Prop. Line --------•---•-•--.-.-- �, ° ,,.t, --------------- Date ------------ --- IREPAHt/ADDITION(P v. Sanitation Permit# -------- ----------------------------------- --------------------- ------ Septic Tank (Specify Requiremts) --------- Requirements) �A�.!: Disposal Field (specify ---------"'-"'"-R"�-" _ - ----"F3 -- k7=�-------- - ------ ------ ---- - �,, � (D aw existing and required addition on re rse side)y k will be done in accordance with San Joaquin plication I - I hereby certify that I have prepared this apand that the won 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: "1 certify that in the performance lof the work for which this permit is issued, I shall not employ any person i11 such manner as to become subject to Workman"s Compensation laws of California." Signed --------- --- -- - - ------------------------------ Owner --------------------- eJ-tel r ~ Title ------------- --------- By -------BY ---------- -------- --- -- (If other a owner) FO DEPARTMENT USE ONLY ; F APPLICATION ACCEPTED BY DATE _".�ti-------- --- ----------------- i I� - - ------- ----------------•------•----------------- --- �--------------------�----------------- BUILDING -- ---------------- ------------------------------ DA PERMIT ISSUED "-.---=---�--�----�- --------- ----- ADDITIONAL COMMENTS ----- --- E i %. �- --------------- ----- ---------- ----- -------------------------------` --- k ;4 -- -------------- - --------------------------------------------------- Date----X0 ' f=inal Inspection bY: - --- - --- ----- --- ----- ----------------- - � • I SAN JOAQUIN [kOCA�L [HEALTH D �R1CT E,,H. 9 1-'68 Rev. SM _. _.