78-509 - Laserfiche WebLink

Home Browse Search

FOR-OFFICE USE: FOR OFFICE USE: APPLICATIOIIV FOR SANITATION PERMIT -- -- --- -- ------ ------------------- --------------- d [Complete in Tnpficate) Permit No._ __-_--5 - --------------------------------------------------------- �* 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 to compliance with County Ordinance No, 549 07d existin Rules and Regul ions: JOB ADDRESS/LOCATIO _ 4 :�1-_..-- -'------ ------ ---- -- - ---CENSUS TRACT-----------l-- - Owner's Name �_.= ti =---------------------:,---"I"T-----------`------:------'------`-- --Phone -'_T7� ----- E i . � -- 4.x Address = .7:= _ .' City ---- - --- - . - - -- p 91 Contractor's Name------------ ----------------- -Xrs_/J ----rice, e # -1� -__"Pflone-- ---------------- --- Installation-will se-rve: Residence ❑ Apartme t�House.❑ Commercial ❑ Trailer Court ❑ ;. . .. � ._ :.... .._. r Motel ❑ Othe'r',,-.' _g ------- --- r .- Number of iiv-ing units_________________Nurribe` f bedrooms C�a age Grinder___:_.____;_Lot Size.__:_. -------------------- --------------------- Water _.__-_____-_. __Water Supply: Public System and'name-------- ----------------------- -------------------..:--------------------------------------- -------- I-__Private ❑ Character of soil to a depth of 3 feet: - Sand ['� .Silt❑l'I,'Clay.❑ \Peat ❑ Sandy Loam ❑ Clay Loam ❑ e Hardpan ❑ «lAdob �_Fill Materia!_. If yes type !-�------------------ A o . � - '—- I hl (Plot plan, showing size of lot, location of syst enr'jtelationo wWts:'�riildings,,etc, must be placed on reverse side.) NEW INSTALLATION:" (N6.septic tank or seepage .pif permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK [ ] Size-------------------' --------_--------_-------------_-----Liquid'Depth------i--------------------- Capacity--- -----------------Type-------------------:------- --------------------Ca acit _Material___'-----------------------No. Coal artments_ -__-_-__------------------------ i Distance to nearest: Well-------- ------ _--:___---Foundation i.-Prop. Line--___- - _ --- LEACHING I i � �------•--- is - LEACHING LINE. ['] No, of Lines-:------------------------:,.Len.gth of each line .Total Length____________________ __ ______ "D' Box -1- aterial_E- - -- --- -_ ----- _ __Type Filter Material_______________ __Depth Filter M -., :...--•r .i r _Foundation---=---- -' r Distance to nearest: Well-_\__ __ _.Property Line :_______ _ SEEPAGE PIT ;[ ] Depth k_-:_._.Diameter`. N,umber -______ ] F Rock Filled Yes ❑ No' Water Table Depth.-'-:----'-" ------------- - --------------------------Rock Size --- -_ ----------� bistanceao nearest: Well_ - -'---- ------------------------------.Faundation__•--- ------------------Prop. Line-----.- --------------:'__ REPAIR%ADDITIONj(Prev. Sanitation Permit#--'------ ------------------------:--.-,Date -------= j = = ----1 Septic Tank (Specify Requirements] :__ = ------- - = _ -------•- - Disposal. Field (Specify.Requirements)i------ =-- Q= - -------------------- -- -- -- ----- --- ---------------=------------ - ---------- Jul _:---------- ] g � q '_�`- -----------------=----- Y Y -------------------- P pP �.-. , Draw-existin clnd-re wired addition on reverse side)" I hireb' certify tht I have pre cared this application and that the work will -be done in accordance with SanA'Joaquin County Ordinances, State oLaws; and Rules and Regulations of:the San Joaquin Local Health District, Home owner or licensed agents signature certifies the following: "I certify that in toe performance ofAe'work'for which this permit is issued, I shall not employ any person in ouch manner as to become subject to Workman's Compensation laws of California." J 5tgnred - - t --- - --(a_& ( � - � - - Owner -- --- ~BY - ------ _ ----------------------------- _Title �--� ti-�--}- - �- - --------- ------------�------ f other than.owner) FO DEP RTMENT USE ONLY �1 _ 3 [ �-- -- -- -- --_ E APPLICATION ACCEPTED BY= = ------ -- DATE 7 DIVISION OF LAND NUMBER. -'-------------- ---- - -:- = `"•p - -- -- -:.-_ --.-- DATE- -------------- --# ADDITIONAL COMMENTS .- .-a 3 = = --- ------ - r� _ . _ -----------------------r-------------------- ---- ------ - r --------------------------------------------- r� 1 ---- Final..Inspection �s --�- .w. fff 1 spectian�bY�--- --- -- �-- - - - -- - - ------- -- w--�� -='------------------ ---- Date--- -- -- -- --�-f- --�-�--'------------- EH t3 24 S JOAQUIN LOCAL HEALTH DISTRICT F&S 21677 REV. 7/76 3M