78-982 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: �, c. APPLICATION FOVSANITATION PERMIT FOR OFFICE USE: (Complete in Triplicate) Permit No. �. 5,.��'` {` --••---- ----- --•. .......... ...... ............ � Date Issued. /•-.7'��:� ........ --•--- ------------- ---------------- This Permit Expires 1 Year From Date Issued. 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 existin' a Rules and Regulations: _ JOl3.ADDRES5/LOCATION r T 3............. .�1`T-� �_:.--CEN$US TRACT.......................". Owner's Named `-- `.1 .'...--� .:...--.. '�✓Y'�' 6�.S�b�6 - ... �-- -- .......:... ..Phone...--"-......:----------- Address--- -:----•-Address---- ...--- .`�'l 76L....- ---- License # .-` -3. ...Phone. --d.�7- -"- Installation will serve: Residence-❑_ _Apartment Haus Co ercial ❑ T filer Court El. i Motel ❑ Other-. E—' _L..-.-.----s-s-i Number of-living units;. .........Numb6r of bedrooms..-_..__a_ Garbage Grinder............Lot Size..-._. .�� ...... . .. a . Water Supply" : Public System and name_...*` ..... ---------------.Private ❑ i Character of soil to a depth of 3 feet:- • Sand ❑ Silt❑ Clay ❑ Peat ❑ Sandy Loom Clay.Loam Hardpan ❑-- .Adobe [. ._.Fill Mater-ial.......�__-1.f.y_e.goypje.___-----------_---- - �. (Plot plan, showing size of lot, location of system in relation to wells, buildingsr etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit.permitted if pyblic sewer is available within 200 feet,} PACKAGE TREATMENT [ ] SEPTIC TANK [ ] ize.....- . x/ .-.-.....-------------------------Liquid Depth�_7._ --.- Capocity�a_V ------Type:........ ..... Materia l. '--._No. Compartments-.-_-.-- --------- 0�_ Distance to nearest: Well-:---1 --..--- :''.'._---.-_,._-_-Foundation:._ "�. . ..... 'Prop. Line....-- ----.--.•- qq��r. e LEACHING LINE Na. of Linesc+Sf++[..�(��-.-_•.....Length of each line.---.----------•-------------Total Length ......_....--.-.-......---....----.--.• j�j7� �rD A D' Box--..........Type Filter Material........ ... ... Depth Filter Material.. ... --------- ..... ` e r•fi 1 Distance to nearest: Well....C��T?................Foundation...lam--..-_....-_.-_...Property Line..._-- '-- SEEPAGE PIT [ ] Depth...... ... .....Diameter------------.--..---Number----�.----------.-.---.--.-._-. Rock Filled Yes ❑ Na ❑ Water Table Depth------------------------- a - -�- -:-�-�-------------------f-Rock Size.....::._..:?.�.- •--- -------------" --Distance to-nearest: Well-----------------------_-------------------Foundation_.-.7-___---- - . -.....Prop. Line..--..-.-----_-..-.----- REPAIR/ADDITION (Prev. Sanitation Permit#----------------------------------- ---------------Date........f-••---------...-......... ---- } Septic Tank (Specify Requirements)' .--- -- ......... Disposal Field (Specify Requirements}- r `�..... r. C _ _„ i ................... ----- ----------------- -- ---- -- - ---- ..~:._.--•------ -------------------------- R - M .. ----------- -------- _ (Draw existing and required addition on reverse side} v - I hereby certify that I have prepared this application and that the work will be done in accordance withx Sano 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 cern that in the S certify performance of the work for which this permit is issued, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed.-- ..... Owner i a sy.......... oaf�............................. CL/U. ........ ..Title----------- (If other than owner) , FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- ........ ........DATE .._ --...........------... DIVISION OF LAND NUMBER.................. DATE-- ....... ADDITIONAL COMMENTS..----_....... ..... ---------------------------------............ ............ ----------- ------ ------------------ .......... ----- ------------------------------.---- ----------------------------------------- ---------- . ....... --... . .... .... ----------------------• ..---------........ -"----t .-.. ..- --- Final Inspection by - - --.......---...-:..----------------------- Date .. . _ E!i 13 24 SAN JOAQUIN LOCAL HEAL (STRICT F&S 21677 REV. W6 3M