78-329 - Laserfiche WebLink

Home Browse Search

,I FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ' ---- ------------ 7f '��_" (Complete in Triplicate) Permit No._. __ _'_ .__ ----------------------- - -------------------- Date Issued_.__--__._ //-Tf -------------------_"__ ___ ___ _ __________________ This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application made.in ncoompliance with County Ordinance No. 549 and existing Rules and Regulations: . JOB ADDRESS/LOCATION - ___-- ---------- _-- 1V ---------- :_CENSUS TRACT . --- --:--- Owner's Name � �' L � �� ----- Phone - ""- Address ---------- City _ Zip U _W i - - -�--- - -9c " "_ Contractor's Name---1 K_C_"------ =-_ j�a�e�/�_, _____________License J __7 ______Phone__J4 installation will serve: Residence Apartment House❑ Commercial ❑ Trailer Court ❑ :. . Motel❑ Other------ ----=--=---- - ; Number of hiving units-----------------Number-bf-.bedrooms---5...-_Garbage.Grinder=r_.--..._:_Lot:Size_.__.__:_-- _ ----------------- -------- Water -----Water Supply: Public System and name:-- --.---.'---........ ` _ - ---------------------Private -- - ------ --- - Character of soil to a depth of 3 feet: Sand [� Silt Clay ❑ ' Peat❑ Sandy Loam ❑ Clay Loam ( - �.. - ----- ...... Hardpan L] do Abef(] b. Fill Materidl--.--?------If yes, type------------------------------"_ 7 {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 permi#ted )f pblic saver is available within 200 feet,) PACKAGE TREATMENT ['] SEPTIC TANK [� "• "T Siie:'.____ ----xI� '7-....Liquid Depth.._s $`._____--_. p y_,160 � ' . _::__Material----- ----------No. Compartments--:--�..---------------------- Distance -�-:-------- --"_ ' :. .. . Ca acit � - ----.,Type,--------------- - + a Distance to nearest: Well------- _�.___. _______________'Foundation_4)---- _------------Prop, Line._d-�----„_..____: _. LEACHs Length of each lin I ING LINE . [4]!No. of Lines.- ---------`---_, -' e-------------- -=_---- - --.Tota! Length.__:f�+0_----.---------_----,_-`-- � h / 4 'D' Box-�� -Type Filter Material_ . _ ��-Depth Filter Material_. ___-_______. _____. ' Distance-to nearest: Well__�0-____------______Foundation--, }_--_-___-__.Property Line ------------------------------------ I SEEPAGE PIT [�]� Depth' Diameter_:____' -__-Number .........___ � Rock Filled Yes�— No 0 ; x . is Water Table,Depth---------- �------ ---Rock Size------------------- --------------------------- "t----- Foundation.`- - r Distance to nearest: Well-------- -4 ------"----- ------------- Prop. Line__Ik ---------------. REPAIR/ADDITION (Prev.-San'itatio' n Permit#__'.----------- ----------------------------------Date------- --------------- - -----:---: ------ ,------ ----- ) 4 _ I -------------------- rf� Septic Tank (Specify Requirements)-- ----- . F I Disposal Field (Specify Requirements)-------- ------------------ - --- ----�”------ ------------------= '=q ------ --------- --. r - -. --------------------------------------------- ----------------------------------- -------------- ---- ---- ------------- -- -----.------,---------------------------------------------------_ - (Draw existing and required addition on reverse side)= s ` � 4 I hereby certify that'l 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' Sari Joaquin Local'Health District, Home owneror licensed agents signature certifies the following: - E F' ►� '.1 certify that in the performance of'the-`work for which "this'permit'is issued; I shall not'emplo,y,any�person in such manner as to become subject to Workman .Compensation. laws. of California. k y Signed----- -------- =-- ----,-:----------------- -- -------- Owner By-------------- --- : .� '-.----- ------'------: ---------------------- = ----'Title._ I ( f other than owner) # FOR DEPARTMENT !PE ONLY APPLICATION ACCEPTED BY- - DATE.._. -. -- -- -:--- ___-- I DIVISION OF LAND NUMBER---------------------= = --- '------ ,-- ----------------------------------- - .-- ---DATE------ ---- ------------------------- ADDITIONAL ------ ---------- ---ADDITIONAL COMMENTS--------- ---------= --- --------------------------- -- ---------------- - - --------------------- ----- ----•------------- ---- --------- -.`--- == = - ----- ----------- --------------- ----------------------------------------------------------- - . .� - -------- = -------- Final Inspection•by�----- ` _ `-- ------- _ _ Date EH 13 24 y _ _ - --F&5 21677 7176.3M SAN JOAQUIN LOC L HEALTH DISTRICT