78-621 - Laserfiche WebLink

Home Browse Search

I4 FOR OFFICE USE: FOR OFFICE USE.- ft SE:., l/ APPLICATION FOR SANITATION PERMIT ------------------------------------------ (Complete in Triplicate) Permit --------------------------------------------------------- Date Issued---;?n 2,6 -7 --------------------___-__-.---_---_--------_____....... This Permit Expires 1 Year From Date Issued App ication is hereby made to the San Joaquin Local Health District for a permit to construct and install t e work herein described. This application is made in co mpliance with County Ordinance No. �54.,9�and existing Rules and Regulations: JOB ADDRESS/LOCATION _.... ----- ---- ¢� •��'y______ CENSUS TRACT--------------f Owner's Name---------- -- -- 1�Address------------------- �'l_ 0-- Ci zi�°tY- ---- P Contractor's Name-------------- --------------.----- --- - -� 'T�(a�------------------License #_ `f�. _Phone-- Installation will serve: Residence X Apartment House-E] Commercial ❑ Trailer Court F1Motel [:] Other--------------� - --..---- --- . Number of living units:---- -----Number of bedrooms...4�-----Garbage Grinder_-----------Lot Size----2_. [x.1 ----------------------- Water --------------------_Water Supply: Public System and name----------------- ------ -- -------------------- ----------------------------------------------------------------------------------Private Character of soil to a depth of 3 feet: Sand ❑ Silt ❑ Clay ❑ Peat❑ Sandy Loam Clay Loam Hardpan ❑ Adobe ❑ Fill Material__.-._..----If yes, type________________________________ . In (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 se,yer is available within 200 feet,[ „ ''" 01 PACKAGE TREATMENT [ ] SEPTIC TANK j-] ize-_.__ --� ; --- "---;-- ----------------Liquid Depth------------------------ CapacCa &cit �� 1L ' ' `_No. Compartments ..__._ I ity - -----TYPe - ------- Material__- .. P ��-------- ------ - Distance to nearest: Well- ^---------------- Foundation f --- --------Prop. Lme--------------- ---------- �I LEACHING LINE [ ] No. of Lines-----------------------------Length of each .lima= .__ ---- Total Length----------_-------------------------- �] D' Box-..-- -.--Type Filter Material-------- -.Depth Filter Material-.-=.:--- ----------------- ---:_ .------------- i Distant&to nearest: Well----------------------------Foundation--------------------------._Property Line-----------------------_--------- SEEPAGE PIT [ J Depth_---------------Diameter------------________Number --------------- Rock Filled Yes ❑ '-,NO[ Water Table Depth----------------- Rock Size,------------___ - �- Dis#ante to nearest: Well------------------ ----- Foundation--------.---------- Prop. Line----------------- ----------- REPAIR/ADDITION - ----------:REPAIR/ADDITION (Prev. Sanitation Per 't# ---v-- � _ ;. ate � ---------------- --------- ------ 1 Septic Tank (Specify Requirements)--- - /�-�'l(J;.- :"�'--""'r---- -------- 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 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 permit is issued, I shall not employ any person in such manner as to become subject to Workman's Compensation. laws of California." : T_ F Signed-------------- -------------- ---- Owner ----- ------------ ------- ----- $Y----- ------ ` --- --- Title - , ------------------ - I other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_ -- --------DATE -------- -. ___7 .___-_ --- DIVISION OF LAND NUMBER -------------DATE-- -------- ----------------------------- ADDITIONAL COMMENTS-------------------- ------------------------------------------------------------------------•------------------------------- - ---- ---- ------ -------------------------------------- ------ ----- - ------- ------ --- ------------------ Final Inspection by:---== *+ Date 7= - EH ]3 24 SAN JOAQ IN LOCAL HEALTH DISTRICT F& 3i REV. 7/76 3M •