78-811 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: FOR OFFICE USE: f . APPLICATION FOR SANITATION PERMIT I --------------------------------- ------------------- 7� 011 --- Permit No. ._...--'-:-- - ---•-- (Complete in Triplicate] I ------------------------------ -- -- - -- Date Issued_-9_,-2.v.-2r ' .......................................____-...._._... 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 Ord'nonce.No. 549 and existing Rules and Regulations: .` JOB ADDRESS/LOCATION .. _._ �.- -------------------- ------..CENSUS TRACT_............. ....... Owner's Name.... ..................... .Phone....-- ...... --: 4 Zi Address_.. ' -----.City..------ _----_ P Contractor's Name.__...: .. f . License # �- --- Phone_ ...I `G + / Installation will serve: Residence � Apartmen House ❑ Commercial ❑ Trailer Court ❑ Mote! ❑ Other_-------------- ------------------ ------ Number of living units:...... ..........Number of bedrooms_--3....Garbage Grinder------------Lot Size-----..- _. ..--- .... Water Supply; Public S ste and name....... ............ ------------------Private r Character of soil to a depth of 3 feet: Sand ❑ Silt ❑' Cloy ❑ Peat ❑ Sandy Loam ❑ Clay Loam Hardpan —Adobe Fill Material'. ._ _-If yes, t e_--n :`--_- lPlot plan, showing size of lot, location of system in+relation to wells, buildings, etc. must be placed on reverse side.). t NEW INSTALLATION: (No septic tank or.,seepage pit,permitted if p1.ublic sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK [ ] Size.... ._. -�'�/�. .�--------- ------------Liquid Depth- ------ ------� Capacity- Type----4.... ......Material._. -------No, Compartments---A----------------------- Distance to nearest Well__... -49-&'7---....---...------------`Foundation----- . �..... - Prop. Line_------.--- - ........ LEACHING LINE [ '] No. of Lines f- Length of each line.--'--%.`-- -------------- Total Length C fly 'D' Box---- / Type.Filter Material..._1,Z . ...Depth Filter Material-_.. _`+ -------------------------- Distance to nearest Well--_.-_{ .. . --. oundatio „_.....:Property Line...._ ----..-- SEEPAGE PIT [ ] Depth.01- .....Diameter..-9.-- -------Number- -_,--- ___...--.... 1 Rock Filled Yes fg( No ❑ Water Table Depth l---------- ----------------- ------------- --•- ----Rock Size. f..:. ----- -------------- Distance to i nearest:lWewll,._-- �U .. Foundation_._ [ Prop. Line..: - _-----/ _._....- REPAIR/ADDITION (Prev. Sanitation Permit#........ ---------- ----- ...............Date................---------- ----.--...._ ------ - Septic Tank {Specify Requirements)---- - ------- ----•--•------- ----------- -- -..-.-------------- Disposal Field (Specify Requirements)----------............._ ------ -------••-------------=------- ----------------------------- ------------------------ ---------------- - ------------------------------------ ---- -- - --- ------------------- ----------- ................. ---- - ---------------- ------------------- - T (Draw existing and required addition on reverse side) w 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: "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.- ... I Signed. .. ....... .... caner •:1 .--------- ..... Title--- ... ----- --- -- f ( f oth than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.............. r. -- ------------ ---------- ------- ....----- ---... DATE ....._. . ..' ..-7 ....... DIVISION OF LAND NUMBER ------- DATE -------- ------ .......... ADDITIONAL COMMENTS. -•--•----.... _.. ............ ... .......... .. ........ --------------------------------------------------- ----- ---------------------- •--••--•------ ......---.........-. .------.------ -------------- ------------- -- --i 41 W__ 'Final Inspection by:..-- bate.---. ...... EH 13 24SAN JOAQUIN LOCAL HEALTH DISTRICT F&S 21577 REV. 7/75 3M