78-107 - Laserfiche WebLink

Home Browse Search

FOR`OFFICE USE: APPLICATION FOR SANITATION PERMIT USE: -- _ / (Complete in Triplicate) Permit This Permit Expires 1 Year From Date Issued Date Issued��'-::...-'4� Application is ereby'made fa 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/L, CATION.. .�,Cy2' 7cuoev ---� -------- ----.CENSUS TRACT.... Owner's Name.,,/ ffIC� eQ5. . ---Phone5 �: Address Q/_..-. 6/ , ._ -.. / _4_ --- City . ontractor's Name ... . �+ f.S �- •r�-s �/ �.. ....License #r 0.1::$ .....Phone.4(P 2'-?6 Installation will serve: Residence [} Apartment Hou4s .0 Commercial ❑ Trailer Court ❑ Motel ❑ Other-. ..f /C.._ Number of living units;................Number of bedr ams---.:.__.-- Garbage Grinder_.- LotSize ,--... ............ ------- Water Supply: Public System and name.-.49A_ , ❑ * ��.. �C� ----------- -----------.Private Character of soil to a depth of 3 feet: Sand ❑ Silt ❑ Clay ❑ Peat p Sandy Loam Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material. ..-- -...If yes, type------- -------•------ ....... . _ v (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 tank or seepage pit permitted if public sewer is available within 200 feet,) _(p' f PACKAGE TREATMENT W SEPTIC TANK ( ] SiZe 'x �K Liquid Depth Capacity-9- 000 T ' --: YP�L�'C��35�-��Mate�rial-�O�!�C��,-Na. Compartments....................... Distance to nearest: Well--.......sem'--Q.�- "• } ` - - ----- .-.Foundation../�,(�iiGe�...-- Prop. Line----7�.............� k LEACHING LINE [ ] No. of Lines...__�i.-6- -..--_.:-.Length of each line,....-_...IC>rC�1- ----- �------ Total Length ...__.. ------- D' Box.-YC�..Type Filter Material_-R,?-" '_..Depth Filter Material......./._�- --............. k Distance to nearest: Well..-- Q-`--.--:-- Foundation----" -------------- ==Property Line---^.-r -* tU.- .....-.-. . SEEPAGE PIT I ] Depth... ............Diameter.............--.-...Number -----------------------------_-- Rock Filled Yes ❑ No 0 — Water Table Depth------------- --------Rock Size..-..... -....------- - - i Distance to nearest: Well--------- ----- ------- ---- Foundation---------- ---- ...-.Prop. Line..--- ............ ---- REPAIR/ADDITION (Prev. Sanitation Permit#--------------- - Date ----- ------- ---------j ; Septic Tank (Specify Requirements)__.. _ .---------- .................... ... Disposal Field (Specify Requirements)_.._.......... ...: ---••-•----------•--------- ------------ -------------------- ......... -- -----------•----•------ ---•----- ---------...........--- (Draw existing and required addition on reverse side) 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 Son 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 permit is issued, I shall not employ any person in such manner as to become ubject ``to Workman's Compensation laws of California." Si y ------------ -- --Owner : - Title. ------------------ (If other than owner) I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY............ ... DATE ....... .- -...- -�- =--- ---- --- ----- ------- ----------- DIVISION OF LAND NUMBER ... ... ...... .. .` __ - _-- -- ..._... . .................... ...... ....... .DATE.......... ADDITIONAL COMMENTSf" /!t_..6 ?r - . ------------ ......�/.. -- -- •-- ----- ------------ Final-Inspection by, ... a = } EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT - F6s 21677 REV. 7/76 3M