77-1027 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) . _ Permit No._ 7_- . --- . -------------------------- -------------------------- ------ �- ',� \-, ,3- Date Issued. 2-`1 Z ----------------------------------------------------_.__ 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 work herein described This application is-made in compliance with County Ordinance No. 549 and existing Rules and Regulations: s r JOB.ADDRESS/LOCATION-_ CENSUS TRACT Owner's Name_.---- { �T .v �:. - Y_ prYrtf - - --- ---- ---- Ph Address---------------------��tL`?-er = City- TYfz' G� o i f --- ------ -------- - Contractor s Name ' A ------ Pte- ---- -- ---------------- License #-_ G6 �_�G---- ne_fO r' Installation will, serve: r Residence ❑] Apartment House ❑ Commercial ❑ ITrailer Court ❑ Motel ❑ Other Number of living units:.'____I=______Number of bedrooms__- .•___Garbage G'r+nd`e'r,.._.________Lot Size______._ ,_. _c_YC• ` f i Water Supply: Public System and fname--___.___._7 �'�G Wi9T�v p{5 r, ` PP Y - ❑ Y ,Clay z ' --- --- -- '' • Private ❑ P P ❑ ❑ y ❑ Peat Sand L�m Loam a Character of soil to a depth of 3 feet: Sand Silt Claf [ Hardpan Adobe' Fill Material____-.------If yes, type_.-._-.___i._____- (� E (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be,placed on reverse side.) r NEW INSTALLATION' '(No septic tank or seeg a e -ppit mitted if public sewer is available within 200 feet,] PACKAGE TREATMENT, [ ] SEPTIC TANKSize _ cSZ + # [ l ;�; ] k ---f---------------- Liquid Depth_,_ _ : Capacity------------- Type;C-=�'`rt_C_: -:. Ma#er•iaa — :No. Compartments.-------- _ Distance`to nearest: Well.= -- ------------i',----_'Foundation_._.____----��----=Pro Line-_---_--�-S�7----------- LEACHI NG LINE [ J. No. ofjLines_ _-___�---------------_ ength of each line---------- ------------___Total. Length.-----------_---__----------- .'D' Box-'------;__Type Filter Mater_i_a_l_----------------[-----Depth Fil-fer-,Moterial------------------- ---------------------------- + ir DistanLcre1-to nrearest: V/e]4�_ �.�._! .. :-----bF{ou�nL. 'f�i,• - -----------------Property Line.------- ' Rck ` y rSEEPAGE PIT Depth--- --------'Diameter]--- ---NumeL„iRockFilled Yes.❑ NoC--- Water-TableiDepth------------------R ize { ------------ =--------------------------------- `3 ;fes tr Distance to nearest: Well_-__- ° _ ______._ t ---------------Foundation. , ------- Prop. Line---------------- REPAIR DITION-(Prev:Sanitation Permit#___--_--________ _ _ - -----Date---- -- = 1 ,» Septic Tank (Specify Requirements) Is m-- ----- Sjei/------ Disposal a` Field (Specify-Requirements)-------------------- . € _ �} ? __----------------------- _ T --------,--------------- - ------ -- ---------- ----------- - , F. � TF-.13sJ , ' `- --A---- -= = ---------------------------------------- ] (Draw existing and required dddition,on reverse side) I hereby certify that I have prepared thisyapplication and that th-b—.vwk`will-b-e done in -accordance with San Joaquin County t Ordinances, State Laws, and--Rules and`Re_gula_tions of the-San•-Joaquin-Low! Health District, Home owner or licensed agents signature certifies the followi g:, "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,subject to Workman's Compensation[laws of California." g �hv/rC� � Spmt Sighed ----- ----�--- 1... - --=------�- "-4�---Owner B � _ ------------+ - Title of er than owner) - t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY__:--- ___ ___-_ _C `` ---------------- -------------------`------'----------BATE ------\'�-:R-�� ' DIVISION OF LAND NUMBER. ----- - ' DATE----- ADDITIONAL . . - --- 7 . , -------- --- - ------= ----- --'.._ ADDITIONAL COMMENTS. }------'---------- -----------------------------------------------------------------------------=------------ --------------- , = _ = = -------------=-=--------- - ----------- -------- ---------------------- ---------------- r = ------------------------------------------------ _ - --------------- ---- --- - Final inspection by == ==_ Dater.' '�- ------------- EH �s sa SAN JOAQUIN LOCAL HEALTH DISTRICT F85 21677 REV. 7176 3M