77-707 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 7 7-rJQ 7 . Permit No----------------------- ------------------------- ---------------- (Complete in Triplicate) Date Issued.. _.'_3��-�- --------------At --C). --------- This Permit Expires 1 Year From Date Issued nd install the Application is herebymade to the San Joaquin Local Health District for and permit existing Rultruct a es and Regulations: work Herein described. This application is made in compliance with County _ T _ �..� - JOB ADDRESS/LOCAT N ..�,. - _ - fi- .. on � ter " - --------- --------------- 1"' ------- e- = ------- `x Owner's Name .._ .: � _ - -------C' Y j -- ---- City ZAP .. . . :.� Address------------- -� -- --- _ a f �.. - -- License #,�. 77-.--------P .one-4 � �a1 Ph Contractor's Name.-__- -- 4 Installation will serve: Residence r4 Apartment House.❑ 'Commercials-❑ Trailer Court ❑ !Motel ❑ Other = = -------"`-- jr t p 64 Lot 5ize..-- --- ---�°` -- -- -------------� Number of loving units:__.._/.._.__..Number of bedrooms__- --Garbage Grinder- - I Private Water Supply: Public System an name.-__----„-------------------- ---- ------ s PP Y� Y � _. - .�-. ❑ y Peat Sand Loam ❑ Clay Loam ❑ R -Character of soil to a depth of 3 feet: and ❑ Silt Cloy ❑ ❑ Y Hardpan Adobe ❑ . Fill Material— --------------------- yes, type.---.---.-y--------------------- [Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.] f NEW INSTALLATION: (No septic tank or seepage pit permitted public sew% is.availabl! `thin 200 feet,} � -----Liquid Depth--- - PACKAGE TREATMENT [ ] SEPTIC TANK ”[ ] Size s lJ � aterial( � 8 o• Co mpartments � CapacitY�- .Type-,G225 -r ` Prop. Line-----�'- --------- �I _ 'Distance to nearest: Well-- -_.,._. == Foundation_:.---f'-- 1 ,t. --.Tota t -- -- --------------------------- No. ------ -- -- ------- - Length'of.eaeh line. -- I Le h. LEACHING LINE L l No. of LFnes_:r_ -: :_-'-- 9 *- 'f ----- --- I i ' De th Filter Material_.__..._ --.. .. 'D' Box.----�--- ---- V-Type Filter Mat lel - p . s,, -------------------- s _ --- - Distance to nearest: Welly - Foundat- n... ...� -------.Property f ine- - -- { :.. ., �,.. Rock F111 e ❑ N ^- SEEPAGE PIT [ 1 Depth--------- -=----Diameter-=----- Number - U Filled Yes O �— I -`---Rock Size Water Table Depth ------------------------- - f f Foundation------------ -- Prop. Line--.--------------------- 'Distahce�to nearest: Well--- -------------------------- REPAIR/ADDITION (Prev. Sanitation Permit#---- ----- Date------------------------------------------ - --------.----------- 'Septic Tank (Specify Requirements)_ = ------- ---- -- --- - . t i .�- � F - c t 1 =-------- ------ Dlsposal Field (Specify Requirements) t _= ------------------------------------------------------ --=------------- ------- -- --------------------- -------- ----------------------------------------------- ------------ ---------------------- f ( - ---------- ---------------------'"-------- um County Draw existing and required_addition on reverse side} t application and that the work will be done in accordance with San Joaq tY 1 hereby certify that I have prepared-this app ' Ordinances,' State Laws, and Rule`s'and Regulations of the San Joaquin Local Health District. Home owner or licensed agents signature certifies the following: + ' "I certify that in the performance of'the work for which this permit is issued,'] shall not employ any person in such manner as i Compensation laws of California." to become subject to Workman's _-r -7 n er Sig --------- -- ------ } ---------- Title Y = j (If other than owner) Y FO DEPARTMENT'USE ONLY r DATE APPLICATION ACCEPTED BY--. ' � F DATE..---�-�-_�7------------ ---- I-�`---------- --------- -------- DIVISION OF LAND NUMBER..-- ---------------- ............ - ------------------------- ---------- --------------- ----------------- - - --------------------------------------------------------- ADDITIONAL COMMENTS---------------- ------ -- -- --------- ----------- - --------- ------------ ------ --- ------------ ----- ------------------- -- --- -------------------------------------- ------ -------- ---------------------------------------------------- ------ - Date.__ !- -------------------------- - :N, Final Inspection by------------------- SAN JOAQUIN LOCAL HEALTH D F&S 21677 REV.7/76 3M cK 13 24 ISTRICT