77-977 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT FOR OFFICE USE: ------------------ (Complete in Triplicate) Permit No._�7_-.l77 - ------- ------------------------- Expires This Permit Ex res 1 Year From Date Issued Date tissued-�°z'" --77 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 ADDRES TIO Owner's Name---- --- -' ` ------ CENSUS R - ------- N T -- - -•- ----- ----- Address------ p ---------�------ City. - Zip / -- -- Phone- Address Contractor's Name ` _ t . : ----------- --------------- - ---- -License ---,------ ----------------Phone's'-7 Installation will serve: Residence Apartment House ❑ Com me , Trailer Court ❑ ; t �. .. :. Motel ❑ Other---= '., = Number of living units:-___l_ "_"_Number of..bedrooms- wa x" ^ =--_.Garbdge Grinde.r__ _ -Lot Size--/-- Water Pp Y- Y name--_'_C. �l E- p = --........=----------- --- --------Private u Public S stem and Character of soil to a depth of 3 feet: Sand Silt !Cla ❑ y, ❑ Peat❑ Sandy Loam ❑ Clay Loam Hardpan❑ Adobe, .,.• Fill Materia ------ If es, t Q Y Ype-------------------------------- 4(Plot pian, showing size of lot, location of system in relation to wells, buildings ,'etc.must be placed on reverse.side.) NEW INSTALLATION: - a*• , �(No"septic tank`,or-seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK �."`- i 'Z Size--- tsQ ------ ,r• ; -----,-------- ---=-----------Liquid Depth --:---- ----- Capacity--12- ---- crs - -. Material_ } sz?tx��—._-N . ------ 7 Distance to nearest:.Well,,: Ij,�1 = == := Compartments s 0 om art t g Foundation �� Prop. Line- ZO ---------------- y LEACHING LINE { ] Na. of Lines.*-___._:X� i-_" :" Len"th•of each line,.,,------ n _� ----..__- -:_Total Length. . L`>C2 D' Box. eS-"--Type Filter Moeri �L _--".Depth Filter Material-",----� Distance to nearest: Well-_130" ----Foundation.--:." _- Property Line__.__------------------------------------- Distance .7.0 ` fr .. F" e SEEPAGE PIT , .i. , .... _ ; Diameter.-- 33 umber. = + Rock Filled Yes.[ No Water Table Depth. *._ r [ ] Depth-"�,�______"Diamete ip ----------------------------------- ------------Rock Size Distance to nearest: Well_--j_$P_""""__ --=------------ Foundation. _s5'U Prop. Line ?d- REPAIR/ADDITION (Prev..Sanitation Permit --------=--=------Date------------=------ -------------------------- Septic Tank (Specify Requirements)=_.--_,____---,-------------------------- ----- isposa Field (Specify Requirements)--------:-------- __ � ; -- - ----------------- ------------=---------- --------------- .. _-------------------------------------------------------- ------ -------------------- -- - : ----=------------•------- ------=----------------------------------------=------------ (Draw exist'ing-and required addition on reverse side] I hereby certify that.] 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: '! "I certify that in 'the performance of`:the work for"which this perm'Wis-issued II.sha?IYnot em to an to become subject to Wor s $ f._ „ p son m such manna s t s Ca iforni0. , .. . Signed__..- -----= , . � .. - -- -- ---Owner _ BY--------------- -Title-----------'I j F - (If other thein owner) " � # FOR EPAR ENT 1J1_U ONLY APPLICATION ACCEPTED- BY ----- -------- -� - � - ----------- DATE.-- �(�`-7= a---------------- = DIVISION OF LAND NUMBER-,__��_.___:."_-"-__------ _ --�" -- ---------------------- -- ------- __-DATE---------------------------------------------- 40TIONAL COMMENTS---------------"_-_-- '.-- ---------------- --------- ------------------------ Final Inspection by;-__-- -`�, -- " - - -- ------- _-- Date EH 13 24 -- -- SAN JOAQUIN LOCA!HEALfH'DISTRICT r&s 21677 REV. 7/76 3M