78-496 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: - FOR-CQ.F11C USE: APPLICATION FOR SANITATION PERMIT .7� 51�� Permit No--- ---------- -- ---- ------------------------- --------------------------- (Complete in Triplicate) - f/ 7 'Date Issued-.(Q.�� ThisTPermit Expires 1 Year From Date Issued _ - --------=--------- and install the work herein described. Application is hereby made to the San Joaquin Local Health District for a permit to construct This application is made in compliance with County dinance No. 549 and existing Rule nd Regulations: - - ----------------------- CENSUS ACT. -- JOB ADDRESS/LOCATION -.- 9 ----------- = -------- ' Phone- -,.:-a, � -- Owner's Ndme._,_ _ _ A t ..--- - --- / --..-- -------. Zip � `� - - S- -.City: - - -- ;----- ,�,.. d 0�--- ---- = Address- ? = :5 ' - -- �---- ----License .# / 'Phone_ Contractors Name-..__.._-'_-1 + , Installation will serve: Residence [Apartment House.❑ Commercial [ --�Trailer'Court ❑ Motel ❑ - . Other i Other------------------------=---- --------- s -.----Garbage Grinder-------- Lot,Size: � ��---- - - F s: ber of bedroo _ _ - Number.of living.unit ---- j Supply: Public S stem and no - ----- - --------- Water Private ate pp Y:. y- -- --- Peat ❑ Sand Loam 0. Clay Loam ❑ } ; t J Sand ❑ Silt ❑ Clay ❑ ` Y Character of soil to a dePHard an F1 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.] I NEW INSTALLATION: (No septic tpnk or seepage pit permitted if public sewer , available within 200 feet,) a =� j `Siz _�_ P 1 0111d _ _Liquid Depth_7 --------�-_----h-v' PACKAGE TREATMENT [ ] SEPTIC TANK [ T - ------ C Material_[--di m---'----No. Compartments-------------- ---- -' € . . Capacity_/6-10-0 -- - - - - - �. r ( _ Distance to nearest: WeIL-_16-0--------------- ---------.Foundation.: �---=------_-----Prop..Line_. _Q_____-h--- ---- __Len th of each line7l ___.Total Len th.,'___ 4------ - - ' LEACHING LINE I°7 No. of Li'nes. ____________ __ g �tenaR Depth Filter Material --. ------------------------------- -D' a Box._ . _ __TYPe Filter M / _ �`; _ t —. 1 x . --------- °-'- - ------- - -Popery Lin rest: WellFoundation Distance,to nea � -t . Rock Filled Yes.0 No ❑t SEEPAGE PIT L] Depth-- '-----------Diameter = Number = = = f Water Tabie,Depth-----------------------------------------------------------Rock -- -------------=--------------------.------------------Rock Size, ,Distance to nearest: Well. ----------------- --------Foundation:__ '-.Prop. Line. = IDate---------------------------- ------ --- -- ✓ t ',,'"REPAIR/ADDITION:[Prev. Sar4itation Permit --� - --- - - Septic Tank (Specify Requirements)------------------------- ------------------------------------'----`--- t -- ------------------------------------------------- ----------------- : k Disposal Field (Specify Requirements)-------:__..__.._- , ---=------------�-� - - ------------------ --------------------- �- : ------- ----------------- ------------------------------------ - - --- -- ------ F . - - raw existing and required addition on reverse side) I hereby certify that Ih have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances,- State Laws, andAules and'R_e_gula.tions of the San Joaquin Local Health District. Home owner or licensed agents signature certifies the following:-1-1-i --,. - �• -• erson in such manner ai "I certify that in the p rformance of:the work for which this permit is issue ct; I shall not employ any p q to becom ject. to Wor man's compensation, laws.of California." I ,�j Owner - Signed V_ . Y 1 ?x Fj Title- s4e '-- ) (If other than owner FOR DEPARTMENT USE'ONLY _ - - ----- ------------ APPLICATION ACCEPTED B)'-; ------ ----------------------- ------------------DATE._ ------------- - DIVISION OF LAND NUMBER:.---- =-------------------=------------------------------------ --- DAT -- -.. COMMENTS �`sc. - .C�7 �3/-78 - "'�'�� - ------------------- ADDITIONAL � ---------------------------------------- - -- - ------ i ________________________,_.__ - _ . __________________• .____..---_______---__________--------------------- -------------- __.___ -----__._ _ ------ __-_____ __ ------,- --------- -- - . �' --- - ------ --------- Date.__ �----- --- -•-------- Final-Inspection bY: _ � " Fes REV,7/76 EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F �