77-178 - Laserfiche WebLink

Home Browse Search

PVR VFMCE USE-1 APPLICATION FOR SANITATION PERMIT •7 _/7, ...................................................... (Complete#rt Triplicate) Permit No. ..................... ............................... I. ................... This Permit Expires Z Year From Date Issued Date Issued . J Z —77 Application Is hereby evade 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 Regulationst JOB ADDRESS/LOCATION ' �� fes... ... . . ................. ..... ... ...... ..........................................CEN SUS TRACT .......................... 06 Owner's Name .............717—,. ............. ................Phone Address .. r� . 4g-p ... . ... ............. ............. City .. . �; ... ................. Contractor's Name ... . ' ---•• r •.. ...........................................License#►, ...... Phone 0s��- 4$.7� Installation will serve: Rest once�partment House(j Commercial❑Tralter Court 0 Motel p Other................•----•----• ............... Number of living units............. Number of bedrooms .......Garbage-Grinder ............ Lot Size ............................................ Water Supply: Public System and name .. ........... ......._----------._.....--•--...... ......-•----................. ...Private Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay ❑ Peat d Sandy Loam ❑ Clay Loam 0 Hardpan❑ Adobe`-0 `Fill Material .... If yes,type................ ............ l (Plot plan, showing size of lot, location of system In relation to wells,-buildings, etc. must-be placed on reverse side. NEW INSTALLATIONr (No septic tank or seepage pit permitted If public sewer is available within 200 feet,) I PACKAGE TREATMENT E ] SEPTIC TANK Size__.. Liquid Depth Copaclty f�,Dp• .......Material...................... Na. Compartments _.5 ............ .-- Distance to nearest: Well .. .. .........Foundation hP..... . Prop. Line . LEACHING LINE E ] No. of Lines .-. Length of pach line,........................... Total Length ...:...................... D' Bax Type Filter Material . .. ___ Depth Filter Material -�.' Distance to nearest: Well ........................ Foundation ........................ Property Line ........................ SEEP [ Depth ----- -- ----------- Diameter ................ Number ......-.----_-----------.. Rock Filled Yes ❑ No WaterTable Depth ----•--•••--••-•......................•.._..----Rock Size .............................--- � I Distance to nearestc Well ........................................Foundation .................... Prop. Line ...................._ REPAIR/ADDITION(Prov. Sanitation Permit# ............................................ Date .................................. Septic Tank (Specify Requirements) ........................................................... .. .. `.......:..... ............._................ Disposal Field (Specify Requirements) . .......................................... ...... ................................ i ............................................................ -............................................................................................................................................ 4 ........ ........................ .................. .... (Draw existing and required addition on reverse sl de 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. Here owner or licen- sed agents signature certifies the following: "I certify that In the performance of the work for which this permit is Issued, 1 shall not employ any person in such manna# as to become subject to Workm n Comp ation laws of California. I Signed ....... .......; .__►..._... . -- . Owner ! By .................... .............. ..... ............................................... •••--- Yitte ........................................................................ (If other than owner) f FOR DEPARTM SE ONLY, APPLICATION ACCEPTED BY .... DATE ...c?.o a✓..1 BUILDING PERMIT ISSUED .DATE ....................:::... ............ •----•••.............. ......... ...... -•..... ADDITIONALCOMMENTS ..................................•• ...... ...._._...._..•.....................-- -.............................._...... I� .....•-.._...---------........_.. ----.._._.. .. ..... . . .... ........•---•...................... _.............. ....... . ..__ .......... . . ..__...._........._......•... ................. ......... �' ....................------...•----•...... ... V ..................... Final inspection by Date ._... EH 13 2h 1-6$ Rev. 5K 8/7h 3M SAN JOAQUIN LOCAL HEALTH DIS CT