77-855 - Laserfiche WebLink

Home Browse Search

P FOR OFFICE USE: - FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ---------------------------------------------------- Permit (Complete in Triplicate) Pe Date Issued ..G-Z4F77 _________________________________________________________ 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: JOADDRESS/LOCATION._ �e <j 4. --------------------- B --------------------CENSUS TRACT---- Name__ -.. _ -- = --- ---- -------- Owner's ;_Phone. �r� ,'� O - �D "J .sem Cid -Zi Address-.� ." � -- - - - P Contractor's Name_. _--' ----_=------ License # 4 ____--Phone_.Q-; 5� � -- ------------------- Installation will serve: esidence U;__-Apartment Mouse.❑ Commercial ❑ Trailer Court ❑ Motel ❑;.. Otherr^'---- ------=------------------------------ Nu I mber -----------= ----=- Number of living units:_ ----___Number of bedrooms__;____Garbage-Grinder...;_._------Lot,Size-----------------------------_------ _______.___.____.___._._ Water Supply. Public Sy`. fem�a11d name '---- ---- ------- =------ ---------------_-------------------,----Private ,R� Ch6 ratter of soil tn,�ct�-d epth of 3 feet;.,- Sand aj®�P_e.aY ❑ Sandy Loam ❑ Clay Loam ❑ = Hardpan ❑ f Adobe ❑'� Fill Material-- -- --.-If yes, type------------------------------- (Plot plan, showing size of.flot, locatzi.on"of system i'n-re..lgtion 1'6 w_ell,s,.buildings, etc. must beplaced on reverse side.) NEW INSTALLATION: (No septic tank�ori see age pit permitted if public sewer is available within 200 feet,) ; F l ,. - PACKAGE TREATMENT ]-w--St PTIC-TANK ] <Size-----------------------------------------------------------Liquid Depth.------------ : . Capacity) Q----:--- -- IPeMaterial = = No! Compartments--- - = 0 Distance,to nearest: Well. ._1l`�-------------------------------Foundation-.M. Prop. Line- ;jD------_----------- ' LEACH G'L'INE [ ] ,'Na. of Lines.- ,-------'--+--•----- Length of each line._70— ---------- ----:Total .Length �--�---------------- ` � ].. D' Box 1---- _.Type Filter Material Depth Filter Materia -_ p- --_.----_"------------- --- y , i Distance to nearest: Well------------------r---------Foundation------------------------------Property Line---------------- ________ :__-o SEEPAGE PIT ;[ ] Depth____:_________Diameter----------------44;7_N'umber-------------------------------- Rock Filled Yes ❑ No - @ Water Table_Depth --"- = -------------------- -Rack Size = ' Distance:fo Nearest: Well - - -- -Foundation. , - - Prop. Line = - 7 REPAIR/ADDITION (Prev.:Sanitation Permit#_:`______________________ ___ Date =- ------=---- -=- ---- ] Septic To l (Spec i'fy Requirementsl- -------- y ------------ ---- --------------- -ti-- s c;~ ti Dispos`al Field (Specify Requirements), ------'�-- ----------- ----------------------------------- --------------------=-----------. -------------- ---- -r + ----- ---------------------------------=---- ------------------ -------- ------------------- --------------------- ------- - -- ------------- .... (Draw existing and required addition on reverse side) I hereby certify that'll-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 4he'0erformonce of the-work for which this permit is issued, I shall not employ any person in such manner as to become psubject to Workman's Compenscition laws of California." Signed-----c7" --- . nar C----=- - - -_OW 1 ----------------- -------------- - --_ , BY --- Title (If other"than owner) ; s FOR'DERARTMENT USE ONLY APPLICATION ACCEPTED BY._ ------- DATE. - ' DIVISION bF LAND NUMBER ;*� ,. - = --....DAT ---------------------- ------------------------- 4 - . --� OL COMM ----------- -to, ------------=---- -- ---- - - --- � -------------=------ i - ------;-------------------------------------------- - - -,. _ _ _ r- - ---- - -------------------- ----- ----- Final-in pection•by:.__ � -�- _ - ^--- --- ------------ Date------ '� _ - --- EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&5 21677 REV. 7174 3M # r �