78-168 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ~ FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No.-7f-","��- Jo ------------ -------------------------------------------------- - (Complete in Triplicate) -------------------------------------- .� .. Date Issued- x -- -------- ------------ 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: - rw 7 JOB ADDRESS/LOCATION l-o`-3 ... - -: •_.CENSUS TRACT Owner's Name --- � �` P .. .. o = � ga1 = t ... ,_.. City Zip Address.----------- _ G� Contractor's Name- _.- _ _ a 3 Phone---�- - - - ----------� License # 1S Installation will, serve: 4 Residence�', Apartment House.F71 Commercial ❑ Trailer Court, ❑ F # a Motel ❑ Other---=------------ ------ e Number'of.bedrooms--.3--.Garbage Grinder------------ Size----- '' "�`� - ------------ = Number of,living units:"�_�___�_ - """� - { ' Pr�vat Water Supply: Public System and name--------------- --------------- --------- ------------ . -: e,� Character of soil to a depth of 3 feet: . Sand ❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam.❑: Clay Loam K Hardpan ❑ Adobe❑ Fill Material_..- -. --If yes, type-----.---- _.F"--_._"--------- _ W i I (Plot plan, showing size of lot, location of system in relation to welIC buildings, etc. must be placed on reverse side.) V_Q NEW INSTALLATION:,�.(No• septic tank:or seepage pit permitted-if public sewer.is available within200feet,) r PACKAGE TREATMENT [ ] : SEPTIC TAMC �' Siz ."-��5x ----------------�-------------'-----Liquid Depth- --�r--- E 1 ..kR f P� Material---- No. Compartments- ----_----�'--------------- .Capacity- - Q7P-- ,Type- A. -.-- -- r� _r�� i !6- --- `----._. Distance to nearest: Well------Via_---.>-------------------Foundation- -�-Q--;-. --------Prop. Line---.__." F LEACHING LINE P< No. of Lines., d..-. _:,�Length.pf each line �U _�U-��---Total Length -____lo� ------------------------- Depth -------- ------ 'D' Box___/ ---Type Filter Material .__ "T - De th Filter Mater.ial----Y_!�- '- -------------------------- ----------- - Distance to nearest: WeIL> -------:- --Foundation--'--__RQ--------------Property Line.-, -- - --------------- r -� SEEPAGE PIT Depth.-- _ . ---Diameter."-� -.---_----Number-_-".�--------------------- ,f .� Rock Filled .Yes '- No E] s i Water Table Depth v- -------------------------- --------- Rock'Size.-. 4 F Distance to nearest, WelL-=.--�-1------- ------Foundation".. _G--�----.-----.Prop. Line-_.- - _ REPAIR/ADDITION (Prev. Sanitation-Permit#--------- -------------"------------------`- -------Date------------------- ---------___ -----) =-- ----------------=---------R-------------------------°------------'----=---------.-------l------ ------------------- 5eptic7ank (SpecifyRequirements) Disposal Field (Specify Requirements);----------.-, - - -- ----- --------------------------------------- --------------------------- ------- ----- -------------- ------------------ ----------- ; ---------------------------------------------- ------------------------------------ ---------------------------------- ----- ---------- --------------------------- _ -----------=---------- - =--------------- (Draw 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 Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licensed agents signature certifies the following: "I certify that in the performance of the work for which this-permit is issued, hshall not employ any person in such manner as to becom ject toan s Compensation laws of California." Signed- : a Owner . BY1 a ------ Till �- ' (If other than ci rv__ ) r# FOR DEPARTMENT USE ONLY: -` --DATE 3- ---------- --R APPLICATION ACCEPTED BY__-.."j'-a'---- - ----- - ---- ---------------------------- - - DIVISIONOF LAND NUMBER-------------------------------- ---------------------------- ------------ -------- ------ --- DATE ------- --------- ---- ------------------- ADDITIONAL _"` ADDITIONAL COMMENTS-------------------------- ------------- ------------ ------------- 1-: - - - ----------------- -------------- ---------- a ------ ------------ - - - - A7 Final Inspection b - = � Date s� EH 13 24 SAN JOAQUIN LOCA HEALTH DISTRICT F&5 21h77 REV ��6 3M