77-901 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -y'� Permit No.__�-7""lc------- ---------------- --------------------- ----- - ----------------- (Complete in Triplicate) l/-/ _ `l� --- -------- -------- -------- Date Issued---- ----r------- This Permit Expires 1 Year From Date Issued x Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application ismadein compliance with County Ordin �e Na. 549 and existing Rules and Regulations: T V ` --.CENSUS TRACT------ ------------------- ---- -------•-- - ---------------- - JOB ADDRESS/LOCATION.:_.-------- -- , '��i ------------------.: ------------------- _ Phone-017 ` �� Owner's Name ------ Address- ---. Ph City_ ----------- -----------------Zip-----------------=------------ one Contractor's Name-------------- --- ----- __Sy'- City- License #.--- -- -- - IC_ Installation will serve: Residence : Apartment House.❑ Commercial ❑ Trailer Court ❑ ` . .. _ -r--Motel -]- Other_-__?-- --------- -----=-- ---- ----- -=-- r C J Number of living units:--.--(----------Number of.bedrooms_ 3_—_ Garbage-Grinder -*_'--Lot-Size--_-•------ s-------1 - = I --- -----Private ❑ Water Supply: Public System and name-::-.`..:i ------=---------------=-----------------------. ------------------ - - Peat ❑ SandL ❑ Clay Loam El Character of soil to a depth of 3 feet: ; Sandl❑ Silt E] Clay E] oam_ . .,. . Hardpan Adobe Fill Material---,---,---?,If,yes,type__ ____________ e (Plot plan, showing size of lot, location of system in relation to, weils buildihgs',etc. must be placed on reverse side.) _ . NEW INSTALLATION'-' (No septic tank`Wseepage it permitted if public sewer is available within 200 feet,) i i - , ? - � ----- ----- PACKAGE TREATMENT SEPTIC TANK °`jij.. Size--------- ------------------a------------------------ - p _Liquid Depth-- TYpe -Material �_No. Compartments ------- Cn acit - = Distance to nearest:'Well ------- --- Foundation-__-. Prop. Line = _-__ k f `Len tK'of.each line ti" --- - --- --- .Total Length _ -------------------- r LEACHING LINE. [ .} No.-of Lines._:. _._ r: �_J q k D' Box__'-------„?--Type Filter Material _Depth Filfe`r Material - ---- -----------------------------, ----------- ;:......;.... ._...,�.....� ----- - ---- --------- Distance'to nearest:;Well--------.`---------"-�----Foundation---- - -- ------ -Property Line . _ SEEPAGE PIT [ ] p eC---=--- Rock Filled Yes ❑ No`❑� Depth -------- ------Diameter =------- -----.----N - .- ; p- --um-_ . . .. _ ------ ----------------- Rock j Water Table Depth- . Size J -_. _-- _ _ Prop. L ine--------------------------- 'Distance --- -- -- -- -------- "Disfdnce to nearest ,Well ----- -. ^ - -- - `Foundafion r. --------- ---.Date------- --- -- l REPAIR/ADDITION (Prev. Sanitation Permit#-�`-=`-=��-=-------------------- --�- Septic Tank {Specify Requirements)_- _-- -------------------------------- {— -- ---_ - - ”- - :..__ ' ``.X ZEA ---------------- r o ---------------------- ------ -- Disposal Field Specify,Reggirementsl------- ---------.:=--- ------- ---___ _ ________________________ ___ ____ __ ___ _-_-. ___.____ __ _ _ _- ____ . - _ ... _._ --------' ----- (Draw existing and required addition .-- - i_ + ------------------------------------------------ =---- ----- - de ' r ,. . ,•. _ -�g n ._ n 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'Sari Joaquin Local Health District. Home owner or licensed agents I 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 manners I to become subject to..Workman's Compensation'�laws of. California." Signed - --- = - _ Owner ----- - _:4 ( _- -- - ----------- -------- -- ------- BY-i------ - - Titie (if other than owner) �--- . .; FOR DEPARTMENT USE ONLY "t ` = -DA --- ---------- --- APPLICATION ACCEPTED' BY-- ------ ---- ---------=------ - - ---- ---- ----- ------------- ---------------------- DATE'------------------ ---------------------------- DIVISION OF L-AND NUMBER'------- -------- - ---- ----------- -------- -- .. --------------------------------------- ADDITIONAL`'COMMENTS-------------- ----------- -' -- ------------------------------ k ` f _____ ___ ___________________ - ------------- + . I. _________ __________ ________________________________________ ______-_.___________- ____ _ -______. __- ---__---___-___- - ------.- ----_-- - - ------------------------ ---------------- ----------------------------- ' ---=---• Date / ----- ------------------------ -------- Final -- ----Final Ins ection,b .r --------- --- -- - P y'_---�' F&5 21677 REV. 7/76 3M EH 13 24 SAN JOAQLIIN=LOCAL HEALTH'D--I-STRICT 1