78-814 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: FOR OFFICE USE:: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No.7$-_FI:y___ --------------------------------------------------------- p Date Issued._f7,;r L0-7e ----------------------•--•------------------------- ------------------------- 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 mode in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION_.. �__ -��'---__. ._- _ �_ _ Y/--- -- - _ .. - - -- _ = CENSUS TRACT � } -.. . ---- e-------------------------------------- --- Owner's Name 1/ - - _ 5. .. hon Address --"---- -- --,-- ---I- --- '-- ------'- I p C.ty - f.1 , ' �I License #- s Contractor's Name - + _ z_ Z Phone = { Installation will serve: Residence [! Apart'm'ent House.[ Commercial E] Trailer Court ❑ F t ► Motel=❑- Other- -Jif f v Number of living units:___-___.°-------Number of...bedrooms__._.____.__Garbage Systemr Grinder ._ .____F _Lot'Size----.___._te ------------------ Water __....__.__.__ Water Supply: Public and name__._'_ Private Character of soil to a depth of 3 feet/ Sand ❑Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ :Hardpan Adobe:❑ Fill Material_ :. If yes, type _ ----- ------ -------------- (Plot ___ _-_._(Plot plan, showing size of lot, location ofsystelm in-relation to wells, buildings, etc.:must be placed on reverse side.) _ y a ,, , ? w NEW INSTALLATION--' (No septic tank 'or seepage .pit permitted if'public seer'is available within 200 feet,) t , PACKAGE TREATMENT [ ] ="SEPTIC TANK �-� 4ize - - cr --------------- -Capacity-./ -- ------Liquid Depth ------------ •• �. -Ca acity."/6 _, � :.No. Compartments- ---F "------ Distance:.to nearest: Well ;:__ .__. D . , o -ation_ -...........Prop. Line �_.--_._ _� _-. LEACHING LINE. . • _ _____ 3 ___ -Lengthof each line,----------- Total Length __ ________________ •: D' Box ---- ......Type Filter Material=_ _�-Depth Filter Material----------- -1 ------------- Distance to nearest: Well-".%0--- { ,.� Foundation . Property Line SEEPAGE PIT [� Depth 1_.`r Diameter - _�-�__.3----Numb,er___ _____ -._____:_.__ Rock Filled Yes No E] Af a Water Table Depth---`---------- �`o------ = Rack Size' 1_ X r a Distance.to neprest:Well-- .:_.:___ti'� 0__ ____Foundation.".._1-D-_ Prop, Line - f REPAIR/ADDITION (Prev. Sanitation-Permit#-.--------------------- - Date.---.---w"_:---------____-- - _--- ------ - ----------- x . Septic Tank [Specify Requirements]____. ------------------------------------ - ----=--------------------- -----------------------------------=----------------------' Disposal Field (Specify Requirements)--------- ---- ---- -- ---_- I-----'---------------------------'------`------ ---------------- ---------------------------- ------------- ------- .------------- --------- ------------ I- ------------------------ - = ---------------------------------------------------------------- ------------------------------------------------ -------------;------------------------------- - " ' (Draw existing and required addition on revers _ e side) hereby certify that,[ 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 ar licensed agents signature certifies the following: "I certify that in the perfokrriance 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." l Signed =------------- -- ---' -----------Owner BY �:�� ---------Title. �- -- ---------- - ----------- I k If than;owner} FOR DEPARTMENTl USE ®®ONLY'. . . 4. APPLICATION ACCEPTED BY" - - ----=------ ------ ---------------DATE --- DIVISION OF LAND NUMBER `= -� f = -- " "= = -.DATE------------ - = t' _ L-------------------- ADDITIONALCOMMENTS - w -------------- -------------------- ---- `--- --=-- ---------------------------------- ------- ------------ 4 I-------- - - - __ _________-_ _____._._ " ______________. _-____. --- --------------------' - .r . 4- -_ --_--- ----_ Final-Inspection b - -- -- -� C p Y - ----------------- - - -- - --_------- ='- Date.-------- -------- - { FH �s sa + Y SAN JOAQUI OCAL HEALTH DISTRICT 7� F&5 21677 REV. 7/76 3M