79-33 - Laserfiche WebLink

Home Browse Search

9k ._ i - �• "` FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT q 11 t2Cot -------------=---------------------------------------- (Complete in Triplicate) p q -------- -------- --- ---- f CC) k 9t h Date Issued.I-1 / This Permit EPpires 1 Year From Date Issued it to construct and,install Application is hereby made to the'San Joaquin Local Health District for a permthe work herein described. This application is�de ,1_compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION.- v.rn CoK-------- -� 4----------- ---- -- CENSUS TRACe--.--------------QI • 2 C7. MSA",rl?•9 Phone----.--5. 3-------------- 4 t -- -- - -------------- Owner's �+ --- --- - - Name` `e.u__ t ..... --- -------- -------------------- _ ---------------- -------- L city z p . Address- ---=---- A---- :- - �-•- .?41- Phone=l -------- 6(IQ License #----------------------------- Contractors Name--------- r`- ------------ } : i ` Residence ❑' Apartment House.❑ Commercial XJ Trailer Court ❑ Installation will serve: ... ..] �. . - Motel ❑ Other--- ------- -----=---- ' ... i mber of livin nd name------------------------- ------ .: :_-- Private ------- ---- Nuunits:_ ---- ---- Number of bedrooms,__.____.___Garbage Grin er..---.- ----- o i Water Supply. Public Systema " Character of soil to a depth of 3 feet: Sand Silt 0 Clay ❑ ` Peat ❑ Sandy Loam ❑ Clay Loam 0 � Hardpan❑ s Adobe,❑ Fit! Material---- ;--•---If yes, type-------------- -- -------- buildings, etc. must be placed on reverse side.) (Plot plan, showing size of lot, location of,system in relation to wells, ; � 9 NEW INSTALLATION: "[Noiseptic.tank'or seepage pit permitted if public sewer is available within 200 feet,) SEPTIC TANK ------ -- Liquid Depth P - -- PACKAGETREATMENT"[ }• :- 2 1 Material C eAlch-T- _NO. Com artments--------- r Capacity:__�_6 -; ------'Type _i� .................... - R /S11 ------ ---Foundation-- --a"...............Prop. Line- t Distance to nearest: Well...________---- - ------------ I s LEACHING LINE j,l No. if of Lines_.- `'------------- ----.Length of each line----- wC'-_ oto ngth.__�---------__ D' Box_.:_ -__.___T a Filter Material---------------- .D'epth Filter Material__ ___A -------- 1 Type ;. .� �+ ---- - Distance to nearest: WeIL,___i_5---, --- Founda�on___-_�--_---= -_--_---:PropeDrty Lige.-----�0'{ - - , Roth ❑ - N ❑ t..._ Depth - --- -Diameter ---------�----Number _0-- - -- - _ . � � Filled Yes o SEEPAGE PIT { ] - - - _. _t = Rock Size-------- --------------- Water Table Depth ------ -------------I-- u `'.�__ `T` Foundation - 'Prop. Line------- ------------ Distance to nearest: Well-------- -------------=---:�; -- � (Prev.:San, � -=- �- --=----- --=----`-� ----.Date-- ---- --�----- :------- ----•---A - REPAIR/ADDITION (Prev. itation Permit#-_------:----- 11 -------------------------------------- '- -------------------- ---- Septic - p (Specifyp Requirements)-.yq = -------= a Field (5 ecif -Re uirements)-_- ----------------- ----------------- Disposal 5e tic Tank -_-•--------------- - --- : --------------- ------------ ---- L _ __________________ _. -___-' _ _ ______ ____ ___________________________ --------_-----------------------------__ - _ _.________ _.A. (Draw existing and required addition on reverse side) ` application and•that the work will be done in accordance with San Joaquin County I hereby certify that:l have prepared this app ' Ordinances,. State -Laws; and Rules and Regulations of the San Joaquin Local Health District, Home ov�iner or licensed agents �j1 t signature certifies the following: ) _ "1 certify that in the performance of the work for'Which this permit is issued,') shall not employ any person in such manner as to become subject to.,Workman's Compensation laws of California." # , -- - ' l Owner Signed_ e. :;;. .BY- ------ ---------------------------------------------------- (It _ 3 W other'than owner +. FO 'DEP MENT USE ONLY DATE. _ 1 - APPLICATION ACCEPTED. BY------- ---- -- - ----- ---- f DIVISION OF LAND NUMBER._- ---- -- --- DATE ::--------.. ----- --------- ---- - =------ ---- ADDITIONAL COMMENTS_______--_-_.- _ ` ----- -------------- _ .. --------------------------- -------------- - ------------ --- -------- -------- - - ------- ---- - ------- Date:----� 'ji --7 Final Inspection b _ r F&5-21577 REV 1 EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT