77-774 - Laserfiche WebLink

Home Browse Search

1 4�� FOR OFFICE USE: -.� � -FOR OFFICE USE: � 7 APPLICATION�FOR SANITATION PERMIT � „_ 4 - - Permit No ---------- ---------- -- F (Complete in Triplicates " ---------- ---------------------- ---------= g;,,> --77 Date Issued------------------- ----------_----_________--__"___-___._____.__ 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: JOB ADDRESS/LOCAT^ ION...--. _.CENSUS TRACT te, ----Phone-----Owner's Name------- '- ---------------: -.::-- --:------- = --- t; 6 /Address-------- � - ----------- ----- ---- -------. City - ;.. --------------- --- Contractor's Name------------ - ---License #---'� -- --------Phone_------ ---' -- ---------- 41 ---- --41 ----- i Installation will serve: Residence ❑ Apartment House.❑ Commercial ❑ Trailer Court ❑ _. Y.-.Motel 0 Other---- 04i Z 'ty4 Number of livin units:-_i__l=------Number of.bedrooms _-:�-___-Garbage GrinderkCWLot'.5ize_.--�0.,V—C.4E'S----------------------------- tr Water Supply: Public System and name--- - ---- ------------------------------------' - -- � -- --------------------- . --------- ---._ ----------- --�-_-- --------- Private Character of soil to a depth of 3 feet: Sand ❑ `Silt E] 'Clay Peat Sand Loam ClayLoam 'Hardpan Adobe❑ Fill Material-------•'___If yes, type---------_; --------------- ---- r (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_tarik or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] . SEPTIC TANK '[ ] S1fe, - ---6-_��-�-1L? G_----- -- - '_ '__Liquid Depth ------------------ Capacity_:`4064? Type----. _____ .__Mate,rial_OWCA7,,C_No. Compartments-- _- "?+----------------------- -1:70 ----- - ------------ i. h,-.,rr -:-- - -=Foundation,:`._- -_-_=---- I--Prop. Line-a- ' Distance to nearest: Well-------- ________________ / n r [ LEACHING LINE, [ ] . ,No. of Lines-___.__--/__._"_;____jam' .ngtryh�}gfyeach\lin® 9_`C0___•-_; Total.Length __��_�!_-"--_-________________ I "D' Box -------Type FilterDe th Material-LS A• p Material Filter M ' Distanca:to nearest: Well-.---/)-L?-_-----_'------Foundation__. _--_'---- ..---.Pr"operty Line-------�10-__________ _________ I SEEP E'PIT [ ] 'Depth----1-�'----Diameter-'- r--------- -----------.-------- Rock Filled Yes [ No _. Nu !r <� mbe / Distance to nearest: Well �� = Rock Size: ;�' T' + M Water Table-Depth--"----------- -fJ--------- ---------- ---------------,Foundatiori__--- --- ------ . p. Line__:_.-jC? `_ Pro REPAIR/ADDITION (Prev. Sanitation,Permit#----------------------- -- __'__-___'- Date--------_:____----- ' f Septic Tank (Specify Requirements) : :.. ------ _ _ . _ --- -- -_ 4 A. T ; Disposal Field[Spec fy Requirements)-.. f ------------- ---- ---- ----------- ---------- -------------- --------------- ------------------------------ ---------- --- ---- ------------------------- --- - ----------------- --- --------- - - -- ------ ----------- --------------------------------- - -----=----------- ------------- = - ----------- ,--- --- - --=--- - - --------------- - =------'------=--------------------'------.----------- _ . r �. (Draw existirig and required addition. an reverse side) ' I hereby certify that I`have prepared ,this application -and that the•work will be done-in accordance with San Joaquin Coun Ordinances, State Laws; and Rules and Regulations of.the San Joaquin Local Health District, Home owner or licensed agents signature certifies the following: s "I certify that'in "the performance of the work for which this permit is-issued,-,1 hall not employ any person in such manner as to become suer#. to Work n s Compensation laws�-of-•-California:.. j� .}t I ' Signed------- --- --L1 -_.-_i.:� ' Ct-,.4�, .._. . Clwner r • 1 - - F --.- i -- _--- :----- :F-----: title F } (If'other'than owrierl, f vitt s i f '''•'-' FOR'DEPARTMENT;i1SE ONLY �2" " - a J / y i APPLICATION ACCEPTED..BY---- -r�e-•--- �* -=---------- - --��k=------=- ----------- - ------ - DATE • � - --�-fir__I ----'--------- `1) ' = w DATE = - ---- DIVISIONOF LAND NUMBER.-- ----- ------------=------- ------------- -------------- --------- -------------------- ' ADDITIONALCOMMENTS-------------------------------- ------=--------------------------------- ....... ti - -----------------.---------------------- ---------------------------. -f, Final•Ins ection'b - _ .. -' ------------- Date EH 13 24 SAN JOAQU LOCAL HEALTH DISTRICT Fss 21677 REV. 7_/7� 3M