79-184 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ---- (Complete in Triplicate) Permit No.... ..Z.......... .- .. . .................. ......................... Date Issued..-3.- .t •......•------------------ ....... --.- 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: : .rte, ..--- JOB ADDRESS/LOCATIO --- ----...--- . CENSUS TRACT --- Owner's Name...' .......... Phone.��. 'J-- O i - � � -- CirY Zip.- Address--... !. - -- -- 1. Contractor's Name... .. . : .... License 3 ..Phone.. -:_ --- ----/. Installation will serve; Residence ❑ Apartment Hou C mercial Tr it r Court E]Motel ❑ Other_ sP ! M ... .. . Number of living units .............._Number of bedrooms............Garbage Grinder....- -..Lot Size.................. .. ......_--.:.._------...... ..... .. 1 Water Supply: Public'System and name.. ............... ----------------------Private Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam Clay Loam Hardpan ❑ Adobe ❑ Fill Material.. .........If yes, type---------------------- ---- - I (Ploti plan, showing size of lot; location of system in relation.to wells, buildings, etc, must be placed on reverse side.) vll NEIN INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,} rr _ PACKAGE TREATMENT [ ] SEPTIC TANK `� Size ... _.. ��-�-�-��^- -�--"---�--------------"- Liquid Depth...? - -......---------�• Capacity.f�D�-_ ..Type---- .- . Materia L.--L,B , .....No. Compartments.---- 5 --"-------' Distance to nearest: Well-------.96 _ f.:.... .........Foundation------/©..... ......Prop. Line--" -+..--.--- - LEACHING LINE 'No, of Lines -------- ---------------- Length of each line..._.-.d.-.Q........__ . Total Length :. __ 0....... k 'D' Box_ Type Filter Material _ .. Depth p Filter Material. Oleham... _-_. __�_V................ 3 -�-----.• -. . .. � i+ ------Property Line �- - ----I fi------- ---------- Distance to nearest: Well----- ... `......Foundation--.-.--.-�.. -.-- -------....... - SEEPAGE PIT ( ] Depth......----------Diameter---------------......Number'.---------------------....---- Rock Filled Yes ❑ No ❑ Water Table Depth- -----------------"..---------..........------------.Rock Size.............. ....--- Distance to nearest; Well......... ...... . --.........._k--....Foundation ---------------......._..Prop. Line-----"- -----_---------• I REPAIR/ADDITION (Prev, Sanitation Permit#------------- ------Date------------..................1 _-- ---.------} Septic Tank (Specify Requiremants)... '" —"-- _ } — . -. _ ----"-------------------------- Disposal Field (Specify Requirements).................. . . -- ---- ........ .......... 1 `-�,� ..�.;.. . .......................... ........................................----- --------—, - ---.....---- ----------------_-_- ... ------- ..--. ............. ...................... ------------- --------- -- (Draw existing and required addition on reverse side) I hereby certify that I 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 1 signature certifies the following: i 14 1 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 Compensation laws of California." Signed--- ---- -- --- - ------------ - ------ Owner Title ; y ' By.......... .......... e. -- (I o er than owner) R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY . -. ...... .. ............DATE . ................ DIVISION OF LAND NUMBER------------- --------------------..DATE..... ..._. --- .-------------- ADDITIONAL --------- - -7 ADDITIONAL COMMENTS. ................ ... --- - ---.._ ....... ------------------ -----•------- ----------------------------------- --------"----------------- ----------- Final lnspecnon by:. _.. - . ._� - ------------------ ... ............. __ _..-.----Dare.---- ....--- ........... ...... ....... EH 13 24 •; SAN JOAQUIN LOCAL HEALTH DISTRICT F&S 21677 REV7/ 6 3M