79-394 - Laserfiche WebLink

Home Browse Search

.AFOR OFFICE USE: FOR OFFICE USE: 3:. APPLICATION FOR SANITATION PERMIT 7 �- ------ ---- ------------ -------- - Permit ' (Complete in Triplicate) �__ 1.r Date Issued'/ w_7- _ •-------------- This Permit Expires 1 Year From Date Issued 1 t Application is hereby made to the -AaquinfLocal Health District for a permit to construct and install the work her described. This application is made in compliance with;Co.unty Ordinance No. 549�and existing Rules and Regulations: i .CENSUS TRACT JOB ADDRESS/LOCATION te Owner's Name--------- -- ------- -------------------------- ---------------------- ------ Phone---- ---------------- ----------- - -- ----------- ®® f Zi f--- ------------- Address -� r�' ' 1 City - _ P 01 i_ _License #--- ? .7 --Phone_ _ -9.� '+ Contractor's.Name l� C - ----- - !tC� Installation will serve: Residence Apartment House Commercial ❑ Trailer Court ❑ f Motel ❑ Other = ---------------------------- ------ Number of living units:------ -------Number of bedrooms"q:____Garbage Grinder_ -_Lot Size.____- .__ �� -------------------------- ' Water Supply: Public System and name_______ ______ Private Character of soil to a depth of 3 feet; 5q d; - Silt❑ Clay ❑ Peat❑ Sandy Loom ❑ Clay Loam } j Hardpan ❑''Adobe ""'Fill'Material_ ~"If 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 pelted if p c sewer is available within 200 feet,} PACKAGE TREATMENT [ ] SEPTIC TANK [ ] Sizer - --- -i --- ---------Liquid Depth. ----"" � OK J Capacity., 0� pe. T4'-_ atwial_,CD ki_t f No. Compartments----- -------- ----- --- i Distance to nearest: Well_.__11e0 =.___Foundation s__ __ _.___ Prop. Line-00-------------- jjI lr LINE ]'1 No. of Lines _-- ------, ---.Length . f ea lin . -=_- -- -. _ Total Len �Tn.__•---f.__ _ __ ------ --LEACHING L ,D. Box__: _.__ _Type Filter Material_ ___-_ th Filter Material.____v7n-_ __ -------------------------- ---- --- �� Foundation roperty..Line---- ---------------- "'Distan�to nearest: Wel!__ ___ ___ _ ________ 4. .. SEEPAGE .PIT.' [ ],D.epth-- -------Diameter:/ / /- Number---.------------------------ Roc ---------------- =- ed Yes, No ❑ F�I1 Rock Size ------------------------------ A-Water Table Depth---- -= f _ ----------- a �'` --;-� ' Foundation_ ---------.Prop, Line__ � . D'istance-to nearest: Well______-.__--------- __-- ^- iii REPAIR/ADDITION (PreL. Sanitation Permit#------------------------------------' - --- bate----:---------------------"------ ] 3 Septic Tank (Specify Requirements)_---------------- ------------------- ------------------------ ----- Disposal Ffeld (Specify Requirements)---------- - ------- --------- -------------- ----------- ------------------------ ------------- �,��, . ---- ----------------------- -------------------------------------`---------------- \ r. ______________________________________________________________ (Draw existing and required addition on reverse 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 Joaquin Local Health District, Home owner or licensed agents t signature certifies the following: ~ F ")'cerci that in a performance of the work for. which this permit'is issued, I shall not employ any person in such manner as s fir p to became subjt t tNorkman' Com en anon laws of California." < [. Signed �� =- - ------ - -- - --: -.- ---- ._.... --------- By -- -- -- 4_._ (!f otl:e�tthan .owner)""' , 41 �¢ 0, .� j le FOR DEPARTM T�USE ONLY ! . APPLICATION ACCEPTER BYT= _1_--_y...:. ---__-: -- - -- --`X'--,------------- = ,= DATE. ,, DIVISION OF LAND NUMBER,-- ---:---------------------------- _ ------------------------- ----- --------------�' DATE. • � I ADDITIONAL COMMENTS__.-_�___ __t-----`_<-+- "�`------`1 ---= i -i------------------------------------------------------ ------------------------- aAN, .i ------------------ ------------ y- _ .. . d_� - Finarins ection b `afe- EH 13 24 SAN JOAQUI CQ �`e 1 � F&5�2 EV.7/75 3M �C�+'L��EAL-T�-I tDls�;R1CT��. � (J�