77-738 - Laserfiche WebLink

Home Browse Search

E FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Il � 77-�3P Permit No--------------------- ------------------------------------ ;. - (Complete in Triplicate) --------------------------------------------- Date Issued----- --'- �--�1 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 existing Rules and Regulations: JOB ADDRESS/LOCATION.,._ ,,.. . �� �.;----- � --- -------- - - .CEN5U5 TRACT ------�--------------------- Phone-------------------------- ------ .-Zip---------Owner's Name- . C... ---- Address------------' ` C - - -----� -�"- `)- LIcease # �2_6 h one-------------d - ontractor ----- installation s Name_ _- - 4 installation will serve:p �f Residence [Gf Apartment House.❑ /;Commercial El '-Trailer Court ❑ Motel ❑ Other ` " 3 J—. �. ------------- bedrooms---- F ---------Lot ----------------- --------x- I` .; rlva e Water Supply: Public Syste�rl.and name----------------- '-` P t haracter of soil to a depth of 3 feet: Sand ❑ Silt ❑ Clay ❑ Peat❑ Sand f ------ ------------- ---- ' y Loam ❑ ''Clay Loam ❑ C r . . v Hardpan Adobe ❑ Fill Material_..- If yes; type_--.----__-_-------------- ..ti If V i {Plot plan, showing size of lat, location of system in relation to wells, btiiidings, etc. must be placed on reverse side.} ! NEW INSTALLATION: (No'Iseptic tank or seepage pit permitted if p.ublic sewer is available within 200 feet) , i --- l Wit•.,.-. Liquid Depth.. Size_. ,IPACKAGE TREATMENT [ ] !� SEPTIC TANK" [ I 20 � =-.--T e al ----- No. C-om'partments -r-L------------------------ t Cap i city ----- YP .. Mated Fdunclation__'.--t.5147-1-Prop. Line-----:- , - -- Distance to nearest: Well-------------�- - F . ` I LEACHING LINE [ °9ti No. of Lines..,,_., - __ ---Len,Length of each line__.__�.b_ _ ___________Notal Length _.:7,_�.�-. - --- 9 _ r_._ �l 'D' Box..;__rJ-- -Type Filter Material:_-----T S_.R..Depth Filter aterial_-_ - ---1�.-------------------------------------------- 1. Distance to nea est: Property Line_- ` --- �� , Z V - --------Number--------- -------------- SEEPAGE Rock Filled Yes No ❑ II PIT [ Depth_.--- " Diameter --- - ----- -------- - . Rock Size-- r�L ------------------------ Water Table Depth.----- Foundation- ---- Prop. Line----- -ss Distance to nearest: Well_.__.___.. .---- --------------------" ------------- i1 REPAIR/ADDITION (Prev. Sanitation Permit#-------------------------------- :Date--- ----------- Septic Tank [Specify Requirements)------------------------ ;- 1: Disposal Field (Specify Requirements)-------------•-------- ------------------------------------------------ ------------------------------------ ----------- ------------------------. - -------- __________________________ __ ~ ' ---------------- --` --------------- -- g ------------------------------------ (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 Countl Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District, Home owner or licensed agent signature certifies the following: "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner aa1 to become subject to Wo . an, .Compensation laws .of California." Signed-------- ------- ---- =-------------- - ---------- �. V` ------------------------- ! _ caner y I ------ : (I of er than"owned IF R-DEP RT ENT USE ONLY, APPLICATION ACCEPTED BY------- ---- - -----=-------------- _ - DATE !' DIVISION OF LAND NUMBER------------ -------i -- • ----DATE ADDITIONAL COMMENTS...- - -------------- ------------=--------------------- - ----- ----- ------- FI� ------------------------- ------------------------------"----------------------------.-----"-----------'- _.___ -------------------------------------------- -- - ---- ---------- ----------------------------- - Date Final Inspection b II FRS 21677EREV. 7/76 3N EH 13 24 SAN JOAQUIN LO/ALHEALTH DISTRICT : - �k