79-385 - Laserfiche WebLink

Home Browse Search

F FOR OFFICE USE: FOR OFFICE USE: t APPLICATION FOR SANITATION PERMIT f .................................... - ---..-- Permit N/5� {Complete in Triplicate) i ---. -------•----•-------• ---- --------- 77 Date Issued;�t'l��f.- i ------------------------------- - - - ---- - ---------- - This Permit Expires I Year From Date Issued Application is hereby made to.the San Joaquin Local Health District for a permit to construct ond,install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION. O� .5, C /'-c �/ ......................... ------------ --------- -----..CENSUS TRACT -----•----------.------- Owner's Name. ..- l-�1..: fJELU/�/yh ............... ........ Phone... r� � ! . z6 y/ s'zo Address-.. .` C' ! - (I�/ City ------ S- K .... ._..... . Zip . 5------- 's Name.-.{7/ /Z/ f{ . �5©iUS--- -------------- ----------------- -- ----License #,?�`�-t;N5I Phorie.... -------- Contractor lnstaklation will serve: Residence ❑ Apartment HousCCommeicia! Trailer Court ❑ --------- ----- - .�-�_ _ Mote-I ❑ Qther:-.° :": ------^.^.�.,•—_�a..��. ...ail_ Number of living units:----------------Number of bedrooms... ........Garbage Grinder---.--------Lot Size.----_-.---.- -- ......-- . . 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 ❑ Adobe Fill.Material -...If yes, type----------------- 1 (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 sewer is available within 200 feet,) a i1 PACKAGE TREATMENT ( ] SEPTIC TAMC (L]� Size..-.--....5_.- •8--.-- `-------- ------Liquid Depth.{---� --- ....... z apacy- j - Type.--R -. M - = .. V ... '---- -- - Distance to nearest: Well----------------=----.--.---.---------------Foundation......l..Q - "I-...... .. Prop. Line---.- ... ------.--.. LEACHING LINE (� No. of--Lines-----.---- ---------.:-- '.Length-of each-lina,=---•-4/•' •---�",To al Length .- .--------7— ----------------- i 'D' Box...k�_.T e Filter Material...s --.-r ._...De th Filt it ate ; { " /� =.-3"' ---_._ . p Distance to nearest: Well--.".-- :,-.. Foundati ---------- ..i ----property Line-- -..--;SF. ----- r SEEPAGE PIT { Depth'... *S _ . .Diameter---- -T -- .AY Number- ----------I------------------I Rock Filled Yes N Water Table Depth---------- ----------- -----------Rock Si f. ... X I`z- ----•-- -- ---- ! ? Distance to nearest: Well.--.-_ --------- - ---------------------Found'aeon-------�---- ...- -.....Prop. Line_-_-.�.._� . REPAIR/ADDITION (Prev. Sanitation Permit#------- ------ ----.Dater-----`?-• ..... ) Septic Tank (Specify Requirements)--------- -------------------------------------- ----------------•--- ---------------- ..._. .......... - -- ....... •............ ..... Disposal Field (Specify Requirements)--.-- ------------- - --------------- v{ -------------------- - ----- --------- ------------------------- -------------•-•------ ....... ------------------------------- --------------------_---------------------- - .__----- ------- ` ......... ...... .. ----•- --------------------------------------- --............... ----------.-... -- -------- - (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 signature certifies the following: "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner as to become sub)e t to Workman's Compensation laws of California." Signed---- -- -- - ---------- -----.-....:-- � ---- -----_........- ------ Owner Yom. } I BY..--..-... .. ..�1�� ----------- ---- Title. ES.TI/?? .? : (If other than owner) 1 F R D PART NT USE ONLY / APPLICATION ACCEPTED BY-------- - - ---- -- --F►' . '''. ....... . - .-...- -- -- -•-----•------ '- ----- .DATE .-- .. d DIVISION OF LAND NUMBER--- ----------- - -- --- DATE. :. ..,.-... . ADDITIONAL COMMENTS_........ \(............... V.4:�?�.........vc 4---------------r --- - - ------------ --.-- --------------- -------- ............. -------- .............. - --- --- ---- ----------- -- .. Inspection bC.EZ -----. - ---- - ----Date.--- - -------- .-�--- -.15. .7 --...-- Final EH 13 24 ° SAN JOAQUIN LOCAL HEALTH DISTRICT F&S 21 677 REV Iiia 3N