68-508 - Laserfiche WebLink

Home Browse Search

FOR QFF.ICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. CSB ---------=-------------------------------------------- =This•Perrnit Expires 1 Year From Date-issued Date Issued Application9�s'h'ereby remade to'tlie San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: .,,��,, rr { JOS ADDRESS/LOCATION �--__Ilt.t -------c---.-_ - � � ; p+t. , �, CENSUS TRACT Owner's Name _ t:? rl--.oie P(J� ------ Phone Address - -1 .S�f f 5,- '! `'--/J lI------------------------------' City -----Jef- '`"t------------ ---- Cantractor's Name -------------License # ry _-.- Phone __ ..'''' a- a• Installation will serve: Residence P-A-partment House-El CommeLr4ial []Trailer Court ❑ Motel ❑ Other ------ -- ------------ Number of living units:__ ----- Number of bedrooms ____-.__Garbage Grinder _11d___ Lot Size ------ ---- -------------- Water Supply: Public System and name ---------0Zt_rE-:I� ------------- --- Private ❑ ------------------------------------------ r J Character of soil to a depth of 3 feet. Sand'�5ilt❑ Clay ❑ Peat 0 Sandy Loam ❑ Clay Loam 0 y Hardpan ❑ Adobe ❑ Fill Material ------------ If yes, type ---------------------------- (Plot ______________________(Plat 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,) { PACKAGE TREATMENT [ ] SEPTIC TANK:? Size_____-f __ _ -_ _- .______- Liquid Depth ____ �______.-.- Capacity .---------------- Type ___________________ Material_�feg'6f_ No. Compartments Distance..�to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line ----------------.----- - LEACHING LINE [ ] No.rof Lines ------------ Length Length of each line.__---)_f"--------------- Tota[ Length ----------------- b-' - ' 1D' Box ---1--------;Type,Filter Material:j4c-/4_- ry--Depth--Filter-Material-_=__- ��_---_---_._-- - �. Distance to nearest: Well ------�_ ------------- Foundation �-o---------------- - Property Line __-- ------_----------- SEEPAGE --- ----- j .J- j;Z, SEEPAGE PIT, [ ( Depth __ ______________ Diameter _-__-______. __ Number _._._--___.______--_.____ Rock Filled _ Yes ❑ No 0 I Water Table Depth --------------- -----__----•--------=--------Rock Size i ------------------------------ Distance to nearest: Well ___________________ ° s Foundation Prop. Line REPAIR./ADDITION_(Prev. Sanitation Permit# _______ Date l Septic Tank (Specify,Requirements) ___________________ - ------------------ Disposal Field [Specify Requirements) - �St-------`-------- -- t.G�r- �f/P�(; �r� E -- ------------------------------------ l =----------------------------------------- --------------- ------------------- --------- 4i� -------------------------- -----------------.- ---------'-'------------------------ (Draw existing and required addition on reverse side[ I I hereby certify that I .have prepared this application and thatthe work will be done in accorda�rrce with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San joagirim,Local.,I�ealth District: Horne owner or licen- sed.agents signature certifies the following: "I certify that in the performance-of-the work for-which this permit i-issued, l shall not employ any person in such manner_ as to become subject to Workman's"Compensation laws of California." �# Signed f Owner I By ---- X� J'' /�. ------ AIP -- I r Title - --- -- --- - _ [If other than o er) 1 1=M�-=FOR bEPARTMENT---USE-=0 APPLICATION ACCEPTED BY ------- ----------- - - ----------------------------------------- DATE ADDITIONAL COMMENTS ------------ -� = � i'' 1f� s DATE --:-__r-__ -____- ---------------- 7 BUILDING PERMIT ISSUED ---. _- - _ - ' ----- -------- ------- ------a-------------------------- -------- --- ----- ------------------------------- ----- --- --- ---- - --------- - ---- - - - — - - -------- --------------- - i ------------- -- ------------------ ------- - A' Final Inspection y: ----- - -- ---- --- - - F- 17'.12t.-Z)n- ------•-- --------• ---------------------- _Date --- SAN -SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M