79-218 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: FOR OFFICE USE. APPLICATION FOR SANITATION PERMIT Permit Nor:7!.a i l -- Z3 -------------- --------- (Complete in Triplicate) ------- Date Issued _-a-�_ -_ -7 This Permit Expires 1 Year From Date Issued kt f 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: g orCEN TR CT ------- ------- ---- ------ JOB ADDRESS/LOCATION-----fa--7 SUS A _ � ------- ------- ---'�``�---f- ------------- - -- . Phone------- ------- ---- -- --------�- --,� ___. Owner's Name _ p �/1.c ." -_._.�_ City = Z1 i Address ------ �� `7 - ,� �-� ` ------------ F Commercial Phone_ Contractor's Name------ esidence Apartment House.❑ C------ License #❑-- v T y - ; .. • D,/ r our 1 Installation will serve: ; R LJ Motel ❑ Otherte—. --- -- --= : ' l G rba Grinder -_-- Lot'Size -- -- -- -------- ------------------- 6ef Number-of living units: - -----Number of bedrooms_ _ __ } private ❑ = " = Water Supply: Public System and name--- --- -- ---- - - ----- SiltC1a Peat❑ Sandy Loam Clay Loam ❑ Character of soil to a depth of 3 feet: Sand ❑-' ❑ Y,❑ - r_„�__ Hardpan ❑ Adobe ❑ Fill Materiak.__-.._ If yes,type-- ------------- Hardpan, `- ' r (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) k '! NEW IN :(No_septic tank or seepage__pit .permitted if public sewer is available within 200 feet,) ! ¢ r k J / �� i Liquid Depth µ C SEPTIC TANK .[�f Size__ ._ "-- xundation_--- � .0 rm-Compartments Line.:= ----_--- Capacity-"l.�Q P__*.--=Type: a' - Fo l a o / PACKAGE _ Material-__ '"'�- -r- - p 1. Distance to nearest: Well_..---------�-�---------- • i. / Length of each line._:.' _; ------Total-Length :�--��---------`--------- C LEACHING LINE. [►7. No. of Li'nes,_ -------------- ' D' Box...�'F._;_Type Filter Material-----^-�.: -_-...Depth Filter MateriaL_}__E. __- -:---- ._. tA � Line---- ----- 1 i Distance to nearest: Well-_------ 4---------------Foundation_._.__ ` . -- -.. - N umber_ _- -" '-- property 6 ,. . .. ... . .. . � _ Filled Y Diameter-= ------- ----N Rock °,❑G • es ❑ SEEPAGE PIT Depth_ f S ------------------------- Water Table"Depth ----------------------------------------------- I ------------- ---------------------------- Rock Size r Distance to nearest:Well - - w ----------=-------Foundation-------------- ----- Prop. Line-- ------------------- -- i _.. ; REPAIR/ADDITION (Prev. Sanitation Permit#-..------------------------- - '---------- Date------------- } Septic Tank (Specify Requirements)------- ----------------- ------------=----- --=---------- -=--- Disposal Field (Specify RequirementsJ________________.--..__ ._--------------- - _ _ -----. r -__.____- ___"___q_______________ ___ __ r_ - - _-- ..:-_ -- ____ j--_.___ -- .-_"___.`_ - _____ _________"---r-----'--------.----------- - .. _ a_ s I F' " { r w existing and required addition.on reverse side) I hereby certify that l have prepared this application and that the ;work will- be done -in accordance with San Joaquin County 4 Ordinances, State Laws; and Rules and Regulations of the San Joaquin Local Health District, Home owner or licensed agents r signature certifies the following: "I certify thdt in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner,as to become subject to Workman's Compensation:.laws of California. • � _ .Owner _.: --- Signed------------------ --- ---- --------- ------- I i -- ' --- -- ----Title-��= - ---------------- (If other than owner) _ -F R DEPARTMENT"USE ONLY ' ------- --- ----DATE 3-- Z O ' - - - APPLICATION ACCEPTED BY------ --- -----------------------------"------- DATE_---------- ----- DIVISION OF LAND NUMBER.------------------- --.--------- - -------- f ADDITIONAL COMMENTS-------------- ----- ----------- ------------ -------------------------------- ------------ --------- ------ --- ----------- ----= -------= ---------- ------ ------------ ------------ ----------------------- -, --- --. -- ----------- -- ----------- . ------------------------------- � } --------------------=" a ------------ �• � ------- --- to�- - ---~L/ 7�F85�- -77 REV / 6 3 Final Inspection by ---- -----•=-- r - 216 . 77 EM 13 2a SAN JOAQUIN LOCAL HEALTH DISTRICT } r