78-349 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: _ FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ------------------------------------------------------ ;7j �S � (Complete in Triplicate) Permit No----------------------- Date Issued____________________ --------------------------------------------------------- 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: LlJOB ADDRESS/LOCATION----- -( ��i l r " « 'G' /0" : Rd--..----- ----- -CENSUS TRACT. Ijf! Owner's Name -- ------------ - c7_ -�� / .� '=' - - Phone. . _ -------- y .. . . Addressc�� .. _, ��k �p J'� .. Ci' h I =---------- -------=--Zip--- c -------- Contractor's Name-----------IYalil -----=----- ---------------License #_----kt----------------------Phone-------------------- Installation will serve: ; Residence ❑! Apartment House.❑ C9mmercicfl`❑ ;Trailer Court ❑ Motel ❑ Other--- Q. "�'... t # -_ Number of bedrooms Garbage Grinder--:-T Lot Size .u�O.Ac At Number of kving_units:,-__ g - Water Supply: Public System and name• -v. _ ._ --------------------------� ':-� i- _ .. Private f Character of soil to a depth of 3 feet: Sand ❑ 'Silt❑ Clay ❑ Peat❑ Sandy Loam Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material------------If yes, type-------------------------------- (Plot plan showing size of lot, location'of v..stem in relation to wells, buildings, etc. must be,placed on reverse side.) fn1 PACKAGE TREATMENT SEPTIC TANK permitted if �lblic sewer is vailable within 200 feet,) a` . _ P9 P ��P.� Q �, �� v1 NEW INSTALLATION: (No=se tic tank or seepage e 't , size_____.._.___: A - P a [ 1 [r�Q ------------------- Liquid Depth.. = N , T� Ca acitY---49--C--IC-----Type- � � Compartments----------------------- -- . Distance to nearest: Well---------- - ---------------------_Foundation-.:--�o_.----..._. -_Prop. Line_-.-- --- _ ...... LEACHING LINE [.} No, of:Lines-------- -__--__ g d g s - -------Len Length-of each line----=--- ----- -- � - ._Total Length - - ��.�- _ ---- Y i :'D' Box._;_.4�._._Type Filter Material-"----_.3_-j,a_—Depth Filter Material----------------- .----:----------------------- _------- Distanceto nearest: Well--------I_S-49---------Foundation-...J-1,1117---------------Property Line_ SEEPAGE PIT [ ]' Depth-------- ------Diameter_ ____--_- -.._ Number - -----_ Rock Filled Yes ❑ Noy❑ = j Water Table Depth -------- Rock Size---- , P _ - f`Foundation- - ' Prop. Line ----------- -------------- F Distahce.to nearest: (Nell___________________________________ REPAIR/ADDITION (Prev:SanitationPermit#:_"__::_ ------------------------ -----------`-----Date-- ----- ------------------.'-----------_- -----I Septic.Tank (specify Requirements)= ------ ---------------------------------- -----------------------------=------- Disposal.Field (Specify Requirements)----------------------- ----------- ----------------------------------:-------------------=--------------:--------------------------------- ------------ _________..___________--------------------I------------------------- ---------- -- ---------__-_ ---------------------_. ,. ._ __ _ - _____,____. .___.__ a _.._________ ___. _ __ _ _ -------- - --_- _- -" -' -- --------- -----------------" ------- -----------------..-.._ --------" ------------------------------------- t f (Draw'ezisting and required addition on reverse side) ! hereby certify that.1 have prepa ed'this application ani that the work will-be'done in accordance with San Joaquin County Ordinances, State Laws, dkd Rules and Regulations of the: San Joaquin Local Health District, Home owner or licensed, agents signature certifies the following: "I certify that in'ihe performance of the 'work for which this permit-is issued, I shall not employ any person in such manner as to become subj to.Workmon`s:,,Compensation laws-.of-California." - Signed----- �e j ' � es a i Own , ----- ------ ------'- y t ( - -Title---------------------------------:------.-- --- ---- --------- --------BY - If r other than owner) � ' ! FOR DEPARTMENT,USE ONLY' APPLICATION ACCEPTED _... - - ----- -------- -'..- �.__,----- `----------DATE. -`-- DIVISION OF LAND NUMBER----------------------------- - ---.DATE- ------------------------------------------ ADDITIONAL ------ ' ADDITIONAL COMMENTS.........::........ E = = - -'--- --------- ------- _/ ------------------------------ -- -------- --------------------------------------- ------------- ------------------------------ --------------- ------ --- --------- -----== ----- -----------Date _Final Ins ecfiion by:- ' f = EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&5 21677 REV. 7/76 3M