78-972 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT - ----------- n (Complete in Triplicate) Permit -- °--- x - ----------- --------- 4 a Date Issued_ ------------ �° This Permit Expires 1 Year From Date Issued ' f: 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 Ordinan a No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION.:--= R� r ` CENSUS TACT - -- Owner's Name.- -- P 7 _.. ,_. -- --- one /_ w. Address" City ' . z Contractor's Name--------�_. .- -------: -- - --- -- ---- ----- +. ----L i en+se # a/o.� -----Phone___�""65r / ---- Installation will serve: Residence A artmenf House.[] Commercial E] Trailer Court ❑ ! w ,. ..( Motel Number of living units:_ ---------Nuniber.of bedrooms. _ Garba Grfinder_-___:. __ Lot.Size _ Water Supply: Public System and name - t :- :-- -_.. --- . ~. ------------------------------Priva a.❑ Character of soil to a depth of 3 feet: Sand Silt[] 'Clay [] Peat❑ Sandy Loam ❑€ ,Clay Loam ❑ Hardpan ❑ Adobe ' Fill Mpterial-_.._ If es t ---- Y , , Ype------------- ------------------ # y (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 t � �a1nk or seepage pit perrriitted if public sewer is available within 200 feet,] O PACKAGE TREATMENT [ ] . SEPTIC TANK [ 1 Size_ ___.____________ ______ ______ ____"_____-_ _Liquid Depth----_---------------- Capacity i __._____._.__.Capacity_=._:_r ;Type -------------=-----Mater''iai '`------ ---------------No. Compartments_..------ --------------- Q'� Distance to.nearest: Well------------- - o n f F undatio -- ------------ Prop. Line:---- LEACHING LINE [�]:`�"No, of fines- `� - Length of each lino _'� '"�" .-_Total Length-__._ '__"�' D' Box--..--------Type Filter Material:----------------- Depth Filter Material___ ..f.. _..,: ...,. ...,.- .,yam ------------ - --- -- Qistanca to nearest: Well -=------ ------------- -----Foundation--- --.--- .-------_ '_`:.Property Line- --------- y . SEEPAGE _..- PIT ,[ ] Depth'_�_ -----------Diameter_=------?------::----Number------_--k-_- i= R Filled Y N -7-.._. -------------i- Yes Water—Toble:Depth_-_:____-:" ' u Rock s ❑ o ❑ - Rock 'Size; l Foundati _ = oI --------- I :-- --- -----}-Prop. Line- ------------------ ------ REPAIR ADDITION Prev:Sanitation Permit#"-'-- _"___-________ ____;Date__- ~A ?- istarice.to nearest: Well_°_____________'_ y AIR/ADDITION = M Septic Tank (Specify Requirements)---._>_--- =' = Disposal Field (Specify Requi'rements)_.._. 4 t I = :----------------- ----- ------------------ -- i f ------ - - ------------------------------ ------------------- ------------------ ------------------------------------ -- - -- ------------------------------------ ---------------- -----"--------=-- ------------------_ ----- -----------y-------------- i {Draw existing and required additiondn reverse side(' 1 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: t I "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 becomes blect to..Workman's Compensation.laws .of California.".. . T + I + Si ned" �� g gY ' = _ r --- - --------- -- -------------------- - - ------- (If other-than owner) FOR DEPARTMENT VSE ONLY APPLICATION ACCEPTED BY- _ DATE. f�-= -"-7-5 DIVISION OF LAND NUMBER'----- - ------- - -- ---- ------ -- ---_-.--------- - :-- ---------- ......DATE = ADDITIONAL COMMENTS_----------- ---------------------------------------------------------- .______._ ? ._ _ ,_ .----- ------ ----------------------------n -- , - - _i.;� ----------- ------- ina nspection by:=---_. -- -- --------------.. -"---'--------------------------------------------- - ------ Date----ll. �-�N---------------- EH 13 24 SAN JOAQUIN LOCAL HEALTH DI CT F85 21677 REV. 7176 3M