79-199 - Laserfiche WebLink

Home Browse Search

r FOR OFFICE USE: _ FOR OFFICE USE: i APPLICATION FOR SANITATION PERMIT 3 (Complete in Triplicate) Permit No._7f_./'_--..... ---- ---------------- .. ....... This Permit Expires I Year From Date Issued Date lssuecl_�Application is 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 Re�ulations; JOB ADDRESS/LOCATION.....zz) - - - �.h ?NC TRACT-------•-•------------- - --- Owner's Name. ...... ---• - Phone..) ` I Address......... - �� ....City. -zip . � _ --- ---------- -•• �... Contractor's Name, �'.: 1 License # ....Phone..... 4 Installation will serve ,� t '• p Residence a� Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other----- - - --- - - -------�......----- --- ,.. S r fS Number of living units:-.../-,------Number of bedrooms_.6?,_. . Garbage -.....- -"Lot Size............... ....- . . E Water Supply:.Public System and name.. T �' .+.— �.,r .------ --- ---- - .Q�tFa .. . ......... . ...... ..........Private ❑ Character of soiNo a depth of 3 feet: Sand ❑ Silt ❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam ❑ Hardpan p ❑ Adobe.K 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'public sewer is available within 200 feet,[ PACKAGE TREATMENT [ ] SEPTIC TANK [ l Size -- --- - ----- - ------------------.---------------- Liquid Depth........---............ ----- Capacity------- ------------Type.:-.--......---- ... Material -----------------------_No. Compartments ----- ------------- -- -I 01 Distance to nearest, Well- Length Foundation----._--.TH. --- - --... Prop. Line---. --------- LEACHING ............� ACHING LINE [ j No. of Lines of each line.__------------------- -.Total Length :: .......... 'D' Box..... - ...Type Filter Material___........... .....Depth Filter Material--..............--- - ------------- ------------------ I Distance to nearest: Weil--.-----•----------- ---- Foundation------.--------.---------- -Property Line.......................... SEEPAGE PIT [ ] Depth--- --.-- ...--Diameter--------------------Number.-.--------------------,...__.. Rock Filled Yes.❑ No Water Table Depth-------------------- -------- - ------------- - ---------Rock Size------------ _-_--........................ Distance to nearest: Well-------•-•---------------------............Foundation.......... ---........_..Prop. Line.---- REPAIR/ADDITION (Prev. Sanitation Permit#---------------=------ ------------ --------`--- ..Date.------- } Septic Tank (Specify Requirements)....._-- --------- -- a -`-=-- -------- ------- Disposal Field (Specify Requirements)-- _ ... �. ' r -- -------- ------,r '.22 �P ... � - �.- --------- -------------------- j --- -- ------------------------•- -------------- (Draw existing and required addition on reverse side) + I hereby certify that I have prepared this application and that the work will be clone 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 l 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 ompensation laws of California.". Signed Owner By.. ------ Title--- .. ��.. Of other the owner) r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ' .DATE .� fes. DIVISION OF LAND NUMBER ADDITIONAL COMMENTS. DATE.___. ---•.................. ..................... ................ ----.....-- ......... -- . ...... ... - ... ... ................................... =r_q, .r .. .. --------------------------------------- ---- - - ------ ...... ---------• ------. ...... _ Final Inspecrian b __ Y� - ---- -- - ...-- ---- • --Date --G--�- EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT res 21677 REV. 7/76 3M