77-730 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE. ` FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No___ ____ Date Issued.-x_7..7_ -------------------- -- __ _____---------- ----- This Permit Expires 1 Year From Date Issued ti 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 unty Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ]/ -----�d7/�� .Lt. �.� ------ CENSUS TRACT. n r --- Owner's Name L ` )j Ll i .----- f--------------------------- --- ------------- ------------Phone_ � 4 14 Address--- - w - City-.SrGC d�Cs h� ZiP 4 Contractor's Name- c..l ... -Q_2 [ ,�e------------------------------------License #-18S311/35/_ ...Phone___eI4-j:7,94-p � Installation will serve: Residence Apartment Mouse E] Commercial E] Trailer Court E]II Motel E] Other-7.y i-L i'---�e-s L-,L— / Number of living units:-----f_--------Number of bedrooms---,2,- --Garbage Grinder---------.-_Lot Size-------. - - -------- ! _- \ Water Supply: Public System and name---------------- ------------------------------------------------------------------- --------- -= Private Character of soil to a depth of 3 feet: Sand F] Silt E] Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam Hardpan E] Adobe 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 permitted if public sew r is avaiGbl_e within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK Size_ I-- 'D' - q __ Liquid bepth ------------ Capacity-Al'ojpe -.'U,--�:c `Material_C0111ct1tu-.-----No. Compartments-----�G..---'---- 11 Distance to nearesWell. -�_-_____-------------------Foundation-____-�___--- ----_ Prop. Line___-�i LEACHING LINE No. of Lines.--_---I---------------------Length of ea line..--_`0Q_------------_--Total Length.----1-Q�-:____--. `Box__..--.-.---Type Filter Material Depth Filter Material.-___ -----------------�_----______Distanceto nearest: Well-1.0-------------------- oundation-----t©--------------- roperty Line------------------------ ----------- SEEPAGE PIT Depth_ S-r-__Diameter--,a(0, ----Number-----f -------------______-_ Rock Filled YesA No El� !! 3 '0� ".. Water Table Depth----t .-`I.--.---------------------------------Rock Size-- I �-----�- �'"�-------------- Distance to nearest: Well_. --o- ----------------------_--.Foundation-- 57W-'-------Prop. Line-,;3-0_-------_-_-.- REPAIR/ADDITION (Prev. Sanitation Permit# --------------------------------------.Date------.-----.--_________---..-----.__ -----} SepticTank (Specify Requirements)--------------- ---- ------------------------------------------------------------------------ ------------------------------------------------- ------- Disposal Field (Specify Requirements)------------------- -- - ---------------------------- -------------------------------------------------------------------------- -- ------------- ------------------------------------------------- -- s----------------------------------------------- ----------------------- ---.----------------------------------------- (Draw existing and required addition on reverse side) - r�- 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 signature certifies the following: "i certify that in the performance of the work for which this permit is issued, I shall not employ any posan-M-such manner as to become subject . rkman' Com sation la of California." Signed-- - � -Q,'lltt.� -`�tL By-------------------- --- --/v Title-. ' r� --------------------- V / (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------- ---------------- ---- '1' DATE.------R-6-777-------- DIVISION OF LAND NUMBER. DATE ADDITIONAL COMMENTS-._.. 11.?I-�--7-------- K---- C ---------------------------------- ---- ------------------------------------------------------------ --------------------------------------- Final Inspection by:------- -------------------------------------------------- ` EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&S 21677 REV. 7/76 3M