79-447 - Laserfiche WebLink

Home Browse Search

f � _ FOR OFFICE USE: FOR OFFICE US APPLICATION FOR SANITATION PERMIT Permit No'-7:7._z/V7 --- ............. (Complete in Triplicate) ---------- •-------- ................ •----- Date Issued.,.7�--r.>;_- ---- ............. This Permit Expires 1 Year From Date Issued Application is hereby made to.the Son 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: CENSUS TRA CT-- --------------- ---- ------- JOB ADDRESS/LOCATION__."]....� U., - - - . - -- - --- ---- ---- -•--------•..."------ ." hone Owner's Name Cit ... ..........Zip------------ ---, ----------- Address__�./--�.". . .. _. -- ---- - ----- Contractor's Name.- . - -. --- - --- ------ LicensePhone.)... Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer.Court ❑ Motel ❑ Other------- I - Number of living units:...--1---------Number of bedrooms...._.......Garbage Grinder------------Lot Size--------....... -- -- - ------------------- Water Supply: Public System and name.-... .. -."...-- ----- ... ....... ❑ Character of soil to a depth of 3 feet: Sand ❑ Silt ❑ Clay ❑ Peat J] Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material.. __.. ....If yes, type.......................... - - (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT ( ] SEPTIC TANK [ ] Size __.--- ----------------Liquid Depth Capacity..- ---------Type--------- ----------- Material ....................._.-_No. Compartments-------- ------ -------- Distance to nearest: Well-=---•------------- ......... Foundation.-. . ....... Prop. Line. 0 LEACHING LINE [ ] No. of Lines.........................----Length of each fine ••----- ---Total Length 'D' Box............Type Filter Material_."....... . Filter Material--------....--.----.------------------- --- -- Distance to nearest: Well--------- ------------ -- ....Foundation----------------------- ----Property. Line-"----- -• -...----... ..... E y ❑ SEEPAGE PIT [ ] Depth.-_ ........Diameter--------.... .----Number-.- --------------------------- No El•- Rock Filled Yes Water Table Depth--- --- - --------------------------'Rock Size.-..------ -- ------------ ------ Distance to nearest: Well-_--......................._....... ........Foundation...--......... ........Prop. Line------ - ...... .---jE REPAIR/ADDITION (Prev, Sanitation Permit#-------------- --"----- ......... ....... _.D te.... -.- --•----• ---- - ) Septic Tank (Specify Requirements)-".................." r` ---- -------- ......... Disposal Field (Specify Requirements)....... """" • ------ --- ---------------•--•- --- ----- - ----- " - •--- (Draw existing and required addition 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 taws, 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, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." �rSigned.._... Owner + ....... GAJ (lf other th�nerl FOR DEP T USE ONLY APPLICATION ACCEPTED BY DATE .... . .. f DATE_.._ DIVISION OF LAND NUMBER -- -------- ----------- --------- - --- ADDITIONAL COMMENTS ------------ -- -- ----- ------------------------- --- ----------- ----------- --------- ------------ -------- ......"---- •-•-------- ................ ...:. r ---- -- Final lnspecTion b ------- Date.------ - _�k Fos 21677 REV. 7 76 3 .. $ EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT