77-1046 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Z�r T _ `Permit No. YJ "� `. {Complete.in HTriplicate} } Date Issued--- ---�---- -- ------------- This Permit Expires 1 Year From Date Issued •-- ---------- -- _ mit to ruct and install the Application is hereby made to the San Joaquin LocolOrdanancDesNa. 549 a drexisting Rultes and Regulations: work herein described. s This application is made,in compliance with Y x � - - CENSUS TRACT --------------------- --------- I - -------- --- JOB ADDRESS/.LOCATION . hone. _ Owner's Name- -- ' -- _ _. -- P------------ - - - ----- : ----------- city 14 D Phone- License Y --'-------------- License #_.dzfi_S'3- -.Ph ne L� -- - - Contractor's Name---.�-t-� -- -� � --- Trailer Court ❑ - - artment House.❑ Commercial ❑ . � Residence AP installation will serve: ❑ ys. 2 • Mote{ 0 n�. Other---- - - - ,-- - --� Number of'_iiving units:_:.__/- -"" __Num ber. of bedroomsf ----Garhage Grinder_____-___._Lot,.Size_.__-- -----=-- Private 1 Supply: s t Y Silt - - Water Sur of soil to depth of 3 e tme Sand ❑ ❑ - Clay ❑ Peat-LI Sandy Loam ❑ Clay Loam ❑ r Charade Fill Material-------------If yes, type----------------------------- Hardpan [I : Adobe k t F (Plot plan, showing size of lot, location of system in relation to wells, buildngs,'tc. must be placed on reverse side.} NEW INSTALLATION: (No septic nk or seepage ,pit permitted if public sewer is available withiri 200 feet,) - f ` Siz }T ------- --Liquid Depth.:_'l/ SEPTIC NK [�!" " "-"" � '' I , "- � 1 I - ---No. Compartments------------------------------ 'C --------.---------- ----- .21 - F � --IT e ---- ---- Mate•rial__L�� -- , t �- PACKAGE TREATMENT Capacityl�i �-� i YP, yc, to nea est: --- --------------- Distance = 'Foundation Q Prop: Line. r No. of Lines. _ ------- ..Length.of each line.- ----$ __ ---Total Lenge.= LEACHING LINE. ( ------------------ "D' Box__ _.--TY e Filter ateriaL ' 0�� .D th Filt r Material_ __._ - t ' ZlA, , t . d----- ---- Found tion_. C) Property Line Rock Filled Yesi : Nor❑ � Qistance to mare t: Well_ ��" ___ ""__"-�_ r� ,r Number--.__ _- SEEPAGE PIT I� Depth. ..,P-,5.'---.Di meter - -. - 1Z l �. . c ---, _�'!� --------------------------- water ----------- Water Table Dept ------ - l,-------- --t---- - - Size Distance;to nearest We ° u n Pr p Line.------ -� _--------`, /(ate o . F n - ' � --- -- -- ate- -- ----'--'-------------------------------------- ------. . D 1 REPAIRADDITION (Prey:Sanitation Permit -- --- --- ' Septic Tank (Specify Requirements) ......... -- Y --------=----- ----- - ------ --------------- -- - Disposdl Field (Specify Requirements):_ .--.=_;._-_ _ _.-_.- _ - , { ---•-- -- ..--------------------------------- . -- - E ----- --------- - - (Draw xis • g and required addition on reverse side) 4 I hereby certify that.11 have preps ed this ap licati n and that the work will be done in accardanceFwithSan 3oagvinrCo ty v Ordinances, State Laws, and Rules and R 4qulations of the: San Joaquin Loco] Health District. Ho own 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 onyi person in such manner s to become bject to orkman's Compensation laws of California." , -- � -- -------- =--'Owner Signed-- 4 --------------------------------- ------ ------ i F - .. Title--- -- BY (If other than ow6 r) y k " -FOR EPARTMENT USE ONLY" DATE - � '�' = = '7-----------� APPLICATION ACCEPTED B) --------- --------- - DIVISION OF LAND NUMBER. s 4 _. " ----------a--s-----�°----------------- ADDITIONAL COMMENTS------------------ -------- ---- - - - ------ - - --------- --- ----- = __ ------- VV r s, --------------- ------------ — — ----- F&S 21677 REV 7/ 6 3 Fina! Inspection b ,^ .. - -- --- --- -------- -- -------•----•-•--•----- -------- ----- -- - EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT x"