79-228 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT FOR OFFICE USE: I! (Camplete in Triplicate) Permit No _y--.-------- -------------- -- -------------- This Permit Expires 1 Year From Date Issued Date Issued; -7- _� Application is hereby made to the 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: JOB ADDRESS/LOC TION.....- "- � ' '�_ G Ia/� Q - - ,,,... -h1317 ., . ., --�----- --- CENSUS T Oa t S RACT -� --- �- - ----- Owner's Name.----- � ' Ph t - - -----__----------•--' ---- ---- - ------ = one-C.JIT--�� Address---! --- � oe_ ! r City-r. y ... ------------=- .----zip Contractor's Name ---- - ? C. �r ------=-------License # �- ,'��-------Phone A4;-i 3 Installation will serve; Residence EK Apartment House E] Commercial E Trailer Court ❑ d .0 . .. . Motel ElOther-- = t P Number of living units:- /._.._____-Number of bedrooms.. _.__Garbage Grinder___ _.....__Lot Size(�J!-------------------------- ------ -- ----- Water Supply: Public System and:name.- ;` 1 Private .- ' ---_- ---- # - th of 3 feet: Sand ❑ Silt❑ Clay❑ Peat❑ Sandy Loam � Clt�y,Lac�m� • I C aracter of soli to a de Hardpan ❑ Adobe ❑ Fill Material.-....-'-- yes, type.__.....!__.___.__------ (PI �y) (Plot plan, showing size of lot; location of system in relation to wells, buildings, etc, .mut be placed on reverse side.) 1 NEW INSTALLATION'- --tNo--s6ptic tanks -oC seepage pit permiffe-d-if publ'`ic sews{s available within 200 feet,) w t PACKAGE TREATMENT SEPTIC TANK j� . e ------S �j �Si - Liquid De p - ----`---------------- s .nn- - , . CapacltyI:-----Type-=- - �--------Material.._ -- Compartments--------2 , f t Distance to nearest: Well _ b________________._,_Foundation___ Line_ :. Prop. �. ---------- LEACHING LINE. [4— No. of Lines-:------------ -._-_ d�� 1 I ------ Length of each line. .-- ---- -.-:- .Total Length...._ldv I i ----{ -- , D' $ox.f._Y ---Type Filter Material__-,� , rL�pepth Filter Material-1 oZ_1__..__..-..-` r Distance to nearest: Well ---._ ------- `-----Foundation_./�.�---_ --_I-__.Property Line ,5 --_i_ ------ - Number SEEPAGE PIT [ Depth s 1 .Diameter__._ Rock Filled 'Yes Yis®"No [! Water Table Depth---- - 4 ----------------- Rock Size •�J X-� FouDistdhce to nearest: Well.------------------•-------.--_ - ndation.-/0----------____--.Prop. Line-- d._ r___ _c _ REPAIR/AO rev. Sanitation Permit#._.......:............... ... ! -------------------Date------------- i ,. l Septic Tank (Specify Requirements)--------------_----- ___ 1-1`` _..--- E! ... . ...... ... -..-_ L! ---------------------------------------------------- ----- Disposal Field(Speciiy Requirements[_ : 1 . --------- ----------------------------1 - r --- ' 41 -------------------------- : - - ---- -- ------- --- �f --------------------------------- (Draw existing and required addition on reverse side) hereby certify that I�have prepared this application and that the work will be done in accordance with San Jol,ulin County { Ordinances, State Laws, and i�Rules and Regulations of,the: San Joaquin Local Health District, Home owner or licensed tagents signature certifies thefollowing: ". " "I certify that in the Iperformance of the work for which this permit is issued, I shall not em p oy any person in such manner as l to becomgsuble, to Wor an's Compensation laws of California. '. tSigned--- ni ----------- -.Ow erSY } i_ --------------------- ------------------------------------Title_® - - Z We {!f other flian owner # � FO DEPARTMENT USE ONLY f APPLICATION ACCEPTED BYi :.. u a ^ DATE ... -' Zea w ' 7t� -li �,r, _ DIVISION' IF LAND NUMBER - — `^ `"""'j ' - -- -- -- ---------- _- -----------------DATE ------ i 5 T� ADDITIONAI�COMMEFN ----------------------- ----- ------ ---------------------- I '-------------------- --------- ---- __ I Final Inspection by:--------�---- -- -:r .�_ Date d 1 EH 13 24 �� AXJOAQUIN LOCAL HEALTH DISTRICT F&S 21677 REV. 7/76 3M