77-391 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No.__._.-__-------------- --------------------------- Date Issued-.S /1--77 _________________________________________________________ This Permit Expires 1 Year From Date Issued' Application is hereby made to the San Joaquin-Local!.Health-Distr}ict-for"a.permit to construct and install the work herein described. This application is made in compliance with County Ordinance No.''S49 and existing Rules'and Regulations: . Ta . I J JOB ADDRESS/LOCATION.---- _ . - rA-- --- -- ------i -------- -------.,CENSUS TRACT ----------------- Owner's Name--------------------- /ZA 1. .�._.+.Q_6S7"--- - �--------------------------- ` --- Phone.o�F ' Rd Address--- - ----- ---- C�O -----:11 IN 1_114 E ----------- C Cit `` ��1 ------------------------- Y .4J.._-._. = Zi Contractor's Narne--------------- •_��-cT_ s2lS __ o- lS /�1 -----'-License #,;+ 3 ---Phone-------------6-/ Installation will serve: Residence X Apartment House.❑ Commercial ❑ ,Trailer Court ❑ „ a- Motel ❑ `Other-- r Number of living units:----------- --Number of bedrooms�______Garbage Grinder------------Lot Size . _R-et __._________________________z__-. Water Supply: Public System and name ----------'--------------------------------------------------.-.-------------------------------------------- -.:-- ----Private. , . Character of soil to a depth of 3 feet: ': Sand ❑ Silt❑ Clay ❑ Peat❑ Sandy Loom ❑ Clay Loam ❑ F Hard panAdobe j Fill Material 7` "-1f yes, type----------=-------------------- _ { (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,} PACKAGE TREATMENT [ ] SEPTIC TANK Size_ �A �n� _________________ Liquid Depth _ �______a_ Capacity- -r� -------:TYpe-- R1=-l+a 'T_Mater'ial`�N*y+� --- No. Compartments----_-er�------------- ---- �./ } ; j - Distance toynearest:.Well__��_9-_©.--____-_._,__`_______________Foundation-- �. - _______-Prop. L ----- sp_�___' LEACHING LINE [ No. 'of Lines _•_�__-___________`_______.EenUh0fach lin® _ _�_______________Total Length _._� 2Q_`_______ , __ ssD' Box TYpe Fitter Materiap !1 i i _-_ __ De th Filter Material-- - - _ __ Distance to nearest: lNell !_ 4__ _=_____Foundation___`: ---------`_=_,Property Line] t __-_�— SEEPAGE,PIT � Depth.. i. Diameter '' _-_ Number _____ __' _ ! ,r Rock-rilled Yes No+ fi. 3 p / --------------------- ------Rock Size, `r x.-. f - r i Water Table De th.�_ _.�O_, � � � Ste -- Distance to nearest:. --------------------Foundation._+_�_____ ____ -,--.Prop. Line_____ ________.___-� t til REPAIR/ADDITION (Prev.,.,Sanitation Permit# - `Date -----_- ----------- ------------ --------;__--.---------- --_. Septic -1 -s Tank (Specify Requiremenu---- ., = _°_ _:.:_ _ , Disposal Field (Specify,Requirements) ------ ------ ---------- ---- ------------------- t - ------------------------------------ --- ---------------------- ----------- -- -- - --- --- ----- - ----------- -- ---------- ---- = -------------------------------------------------------- ------=----------------------- - - f {Draw�existing and required ddclitionn rr rse side} I hereby certify that I-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'�JoaquiWl co al•,Health District. Home owner or licensed agents signature certifies the 0o'ilowingc "I certify that in the performance of the work for which this permit is issued,J_shall not me ploy any person ifi such manner as - California: to become. subject t orkman!s I ion w t � , nn s o Signed--- . .�J F r BY ---- - --- -TitleI -------- 3 -- - ------ /� (If ci i'er than'`owner) r FOR DEPARTMENT USE ONLY, APPLICATION ACCEPTED -BY-:------:-L_ _-6----- =--- ------------------------------------------ - DATE S ---------------------- - DIVISION OF LAND NUMBER: _ -------'DATE----- �---I---- -------- ---------------- -- ------------ ==;; w ADDITIONAL COMMENTS----- ----- t .~ -------------------- t u ��* { . -' 4 T-----------------------------_____ -------------------------------------------- ----------------------------------------------------------------------------------------- _'f?'J"_._. ------__ -----------------------2---------------------- ----- _____ I - Final Inspection by �`�' --- -------- = Date- r� E" is 2a SAN JOAQUIN LOCAL HEALTH DISTRICT Fss 21677 REV. 7/76 ane