71-436 - Laserfiche WebLink

Home Browse Search

.. r FOR OFFICE USE: APPLICAVW$ FOIrSANITATION PERMIT ' 'permit No: r (Complete in Triplicate} ;Q,. ----- - . -- --- _ i Date Issue ------------- --- "--" --------------------- -------------------------- - This Permit Expires 1 Year From Date issued ---------------------------------------------- -- - -- - ith County Ordinance No. 549 and existing Rules Regulations-. tion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein Application compliance described. This application is made in comp - .CENSUS TRACT ------------------- ------ JOB ADDRESS/LOCATI -- ---. --- " "- _.Phone/ 147173 "" ---- - -------- -- - -- ----- Owner's Name ---- -- y City _5 t _ �- - ------- --- ---- - ----- Address ------ ---------- r 7 - Li:ense # �Ouy --- Phone ., p�V S_ Contractor's Name ------ -- Residence$Apartment House❑ Commercial ❑Trailer Court ❑ installation will serve: 1 Lot Size - Motel ❑Other -- ----------------------------------------- ---------- ---------------- --------- -""---Garbage Grinder --------- Number of living units:-_/ ----- Number. of bedrooms _. _.__-_Private ❑ --------- Water Supply: Public System and lame --------=----------"-_ Peat El Sandy Loam ❑ Clay Loam Character of soil to a depth of 3 feet: Sa '❑ndSilt❑ Clay Y ❑ ° I` --------- 1 Hardpan ❑ Adobe Fill Material ..- Yes, p Il etcn relatio . must be placed on reverse side.) i (Plot plan, showing size of lot, location ofage e I t permitted if public buildings, is available within 200 feet,) seep 9 p uid Depth ---- --- NEW INSTALLATION: (No septic tank or1Iq P SEPTIC TANK'L 1 Size--------------------------------------- PACKAGE -- ---------- ---------- ---- ----- . PACKAGE TREATMENT [ I p ---- -----• 6 Type -"_- Material------------ No. Compartments s Capacity ----------------- YP Line ----•--•-------•--•--- - � - ----------------------Foundation --------- ---- ---- - Prop. _ Distance to nearest: Well ---------- -------Total Length -------------------------- No. of Lines -- --- --- -- ------=- Length of each line---------------- -� LEACHING LINE. L l Depth Filter Material ............................................ T e Filter Material 'D' Box ----- ---- YP Property Line - Foundation -------------------- Distancelto nearest: Well -- -� Rock Filled Yes ❑ No i❑ _-- Number --------------------- SEEP�PIT [ ] Depth Diameter ------------ ,- -- Water Table Depth -------- •------------Rock Size ---------------------------•---- Distance to nearest: Well -._----.-" ------------ -- -------Foundation ----- ---- -- -- -- Prop. Line --------------- ------ Date ------------------------------ --) REPAIRfADDITION(Prev. Sanitation Permit -------- - - -------------- - Septic Tank (Specify Requirements) -- -- ------ 1 Disposal Field (Specify Requirements) ---- -------- ------------------------ I .: [ --- ------ ---- - ---------------------------------- -- - --------- ------- -----------------------uir d - -- --- " - ---.- (Draw existing and required addition on reverse s!de) R certify that I have prepared this application and that the awork will be done in Local Health District.accordance estawner or 1 cen- I hereby c Y County Ordinances, State Laws, and Rules and Regulations of the q arson is such manner i sed agents signature certifies the following- p to any p "I certify that in the perfor ce of th work for which this permit is issued, I shall not amp y as to beta su o r an's C pensatiopJaWS of California." Owner Signed ------ --- - - - ------ ---------- - --------------- _ Title -- - -- - - --- -- Y -- (If other than owner) FOR DEPARTMENT USE ONLY �' ' --'7/-------------------- APPLICATION ACCEPTED BY . - DATE ------------ BUILDING PERMIT ISSUED -------- ---------------- __ ADDITIONAL COMMENTS ---- = ---- -- —-- - - - ---- ------------------------------------------------------ --------- ---------------- -- - ------ ------------------ _.-------------------------------------------------- ------------- 4 .4 ----------------- - - - ------ ---- - r ----------- - -- ----------- ----- ----- ---�---------4__t" ,Date --- --------- Final ----- ----- --------- --- ---- ------ ------- -- --- c.�it, = -- ---------------------- Final Inspection by: - --- ;1 SAN JOAQUIN LOCAL HEALTH DISTRICT W 0 1-'68 Rev. 5M