70-677 - Laserfiche WebLink

Home Browse Search

/FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT y - -- --- 114�------------- Permit No. 7d-4_7 7 _ c (Complete in Triplicate) This Permit Expires 1 Year From date issued Date Issued _. _.-r ;- -- _ _ _ _ _ � --- --------------- --------------_-____ __ -- ----- Application is hereby made to the San Joaquin Local Health District for a per 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 ._# - - --_ ------C-6-01 MI-0----------------------------- ---- --CENSUS TRACT --- ""------------ p Owner's Name �yl Q r r1111�1 / ' Q �1 --------------- Phone �t-- .--Cl�?__ -0 Address �F .=f----- — L� C�F City Contractor's Name --------------------------------------------------------------------------------------.License # ---------:-------------- Phone ------------------------------ Installation will serve: Residence 8"Apartment House❑ Commercial ❑Trailer Court 10 Motel ❑ Other -------------------------------------------- Number ------------------------------------------Number of living units:--- 1---- ,;Number of bedrooms _______Garbage Grinder --- -------- Lot Size --- ------?--() Supply: Public System and name --- -- =------------------------------ -------------- ------------- ------Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay P?' Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑. Adobe ❑ Fill Material ------------ If yes,type -----_______________________ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if publi _s 9rlis,available within 200 feet,) PACKAGE TREATMENT { ] SEPTIC TANK'�if� Size_1� 1-___� -� __________ ___ Liquid Depth ------ - ------------- �J caPACKAGE [-1^-C__64.04'Material___ o. Compartments ----- ___...... P Ya C7- Type I ._-� _ Distance to nearest: Well ----_ ---_- ________________Foundation __./_0---- _./LQ__r_____ Prop. Line ---J ---_--______ LEACHING LINENo. of Lines Length th 'of'each line Q_Q-�___: Total Length. .--_/d ------------ t ] ow 'j D' Box ----- --- .Type Filter'Material Filter Material ---- - f----------------------------- Distance to nearest: Well __.,�- ,1l___--Foundation -1.6)------ -__ Property4 Line ---6~.__-__-_-- SEEPAGE PIT [ ] Depth ________ "Diameter--�= f=- Number .....-/__________ Rock Filled Yes No ❑ Water Table Depth ------------------------------------------------Rock Size 2 � VVI3 Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ...................... REPAIR/ADDITION{Prev. Sanitation Permit# -------------------------------------- ----- Date -------------- __.__.--•_-- -------) i . 1 Septic Tank (Specify Requirements) ----------------------------------------------------------------------------------- y--•--------------- --------------------- .... . o- Disposal Field (Specify Requirements) _____________________ -- --- ' W h .. --------------------------- ---- --------------------------------------------.. = ," -.:.-.. (Draw existing and required addition on reverse side) ) �' I hereby certify that 1 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 Hcen- sed 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 becorMt a subject to Workman's Compensation laws of California." Owner �Jp i f BY - -------------------------------------------------------------- - Title -------------------t - s (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - _-- DATE'��.. ---------•- "---- BUILDINGPERMIT ISSUED ----- ----------------------- - ------ ----------------------------------------------------------DATE ---------------------- -------------------- ADDITIONALCOMMENTS -------------------------------------------"------------------------------------------------------------------------------------------------------------------- ------------'-------------- ---------------- ---- ---------- - D 111 Final Inspection by. - e ate --------------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT ` .EN. 9 l=YDS evSM M ` .I