79-589 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: �� FOR OFFICE USE: v . .., `APPLICATION FOR SANITATION PERMIT -� ., (Complete in Triplicate) Permit No..7 9.-:5.P.9 -------- Date Issued---7:`- "2.9 ••• •. •---- --- ---- -- This Permit Expires 1 Year From Date Issued Application is hereby made to.the San Joaquin Local Health Districf for a permit to construct and install the work herein described. This application.is made in compliance with County Ordinance No, 5 9 and existing Rules ay l eL/ ul JOB ADDRESS/LOCATIQN._ .. .. - '.. '-...�... _L ..1 .-----.-CENSUS TRACT__' RACT-- ----------------------- Owner's ----------- ------- --Owner's Name..._ .-" /� . -------- .-....PPhhronez Qr....... f Address . . !/ "`•. !h City G.. ....ZiP - Contractor's Name---- . .............License #;7 ,�-..�..� Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer,Court ❑ Motel ❑ Other_..... ....... ----- -------,,,,---- ---------- � •. Number of living units:.....---------Number of bedrooms_ . .Garbage Grinder_/V0__1ot Size.. - Water - ---------- - 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 p ❑ 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 permitted if public sewer is available within 200 feet,) ► PACKAGE TREATMENT ( ] SEPTIC TANK Size+ --------------------------------Liquid DeA Capacity/ _ r ..Typ�%1.6+ ...Mateaial. 'G .No. Compartments. : ............... Distance to nearest: Well.............................. . ... .....Foundat`n-.---- _ ----- .._. . ....._. ....Prop. Line ,----------------- -.. LEACHING LINE �Q, No. of Lines .. ..( - .........Length of each line. - -I -.._...._Total Length .. ._ ..................... 'D' Box... Type Filter Material.� uf1 -_ Depth Filter Material.... 11 Distance to nearest: Well.. .................Foundation- 10----.--„_-- -- Property Line..�7�....... SEEPAGE PIT Depth.�___.Diameterlf5 --....Number.... . --------------- Rock Filled Yes No Water Table Depth--1. ---------- -- - ---------------------------Rock Size.1_77- `. Distance to nearest: Well...��il�______ -----------------Foundation.- -----------------Prop, Line. �Z _.....-_... �_A,"cPA(R/ADDITION (Prev. Sanitation Permit#--.. .......::................... ....-----------Date....--------.----..--.-.:..----.--- ---._--.-_} Septic Tank {Specify Requirements]............-_...------------------------ ------------ - Disposal Field (Specify Requirements)- ------------ -------------------------,---------------------- { ----- --------------------------------------------------..--- ------------------------------------------ ...... -------•---------- -- ------------------- r t (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: "1 certify that ' he performance of the work for which this permit is issued, 1 shall not employ any person in such manner as to become bject to Workman7s Co eja ' s of California.” Signed.. ..... .. . ! ------ -- - --------Owner By------------- i-----• - - ----� . ..... �-----.... Title.-- -.... ...... ... X .._ r ---. --... If ache hon owner} FOR DEPARTMENT USE ONLY F1 I APPLICATION ACCEPTED BY... --- -- -----------------------------------DATE ___.... . r. DIVISION OF LAND NUMBER............... ........ DATE............................. .. .--.-. --- ADDITIONAL COMMENTS........ . . ........ ... . ... .. ........ ' - - -- -------- - -- ----- ------- --------------------------------- - -- - Final Inspection by:.. ....... ('.... -- ...........................Dare .' �.� ...... ................ EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&S 21677 REV. 7/76 3M k