77-455 - Laserfiche WebLink

Home Browse Search

t r FOR OFFICE USE: FOR OFFICE USE: I APPLICATION FOR SANITATION PERMIT J 7_ 4',S- --------------------- k ------------------------- Permit No.--- --------- -- {Complete in Triplicate} --- ------------------------------------ ---- ----------- /- 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 d Regulations: JOB ADDRESS/LOCATION.--- f- -7.- - .----=--s----------- -------------.CENSUS TRACT. - ----_ S� �. ' � _.Phone-- Owner's Name----- a-fit' -- ---------.---------- ------� .? vhf �1VTC, yy�� - - '�C-itY:W4,tLr.'r [ z i P� Address ----- -- �a <C 1 'r --License #- --------Phone=----- ----- ---- w Contractors Name-------- �, f w (- � --------------------------- Installation.wilt server Residence !X Apartment House.❑ -Commercial ❑ -Trailer Court ❑ _ r--- -- --- a�/f •a Motel ❑ Other - -� :_---- --=-�--�e-1 t ----- : -�---� Nu,nber.of living units.___/�._N.um;ber_o£.bedr;QFbms..__.� ge Grinder.. Lot Size----___ Pri Water Supply. Public System nd,*name ---_ -_-_ vat e t Character of soil to a depth of 3 feet: : Sand I] Silt E] Clay F1 Peat❑ Sandy Loam lig. Clay Loam ❑ *j I Hardpan ❑ Adobe ❑ Fill Material_----------If yes, type----------------________________ (Plot plan, shoveling size of lot, location of system in relation to.wells,buildings, etc. must be placed on re terse side.) I �NEW INSTALLATION:'-'- (No;-se tic tank7or sKe- e a e pitPermitted if public sewer is available within 200 feet) oow PACKAGE TREATMENT [--1-"-SEPTIC TANK--[ ] Size--5)IrVAa -x --------- -------Liquid Depth ____ i c- C �'f I _ . Capacity/��" __:---` ype 4 7---- S---NIj terial- No: Compartme is ' --------------- It X Distance to nearest: Well_ ___---- __ I Fou dation 1_�------ --------Prop. Line_ �______.___ LEACHING LINE, [ ] -. No. of.Lines------;- Length of each line . _,_,,. ._ ,_ _.__Total Length ---------- / f 'D' Box :_ .___'. T e Filter Material !� __ Depth FilterjMaterial___ ______;j �! N i ------------------ .Distance to nearest: Well_ - /Q'�_ Foundation_ _ ¢,__.Proper Line_.__ .-Number_- � 3 r---- - ' -... Reek Filled Yes No SEEPAGE 11 PIT I[ ] Depth__ _.__._ .__Diameter- :... ❑ ❑tA Water Table;Depth.-.-- - -- _ _ Size Rock Si = r .{ ,_... - ---- -Foundation _. .�_. Prop Line------------ ----REPAIR ADDITION (Prev; Sariitatibn-Permit#Well_-:_ __------------------------------------- Se -a - \te Septic Tank (Specify'Requirements)---- -- ------------------------------------ = � -- ------- ----- ---4--- s t I Disposal Field.i5pecify Requ,ire-ments)----------=----- ------------ -----------,----------------:---------------- ----;----- ----------- -----------=------------- ----------- ------------------------------------- 7 ----------- - ----- Crr ---- ---- -- ---------------------------------------------- - # a I I - - --- ------ ------ = = = f (Draw existing and required addifion-dh+everse sides hereby certify that I have-prepdred-this application77 d.pl.�ke-,w—ctr.kaer!U-b�.�one in accordance With San Joaquin County Ordinances, State Laws; and Rules and Regulations of the San Joaquin Local Health District, Home nwner or licensed agents signature certifies the following: - � "I certify that in the performance of lie work for'which"this permit is issued, I shall not employ any person in,such manner as to become subject to ork an's Compensation laws. of California." Signed. ........... -- -.... : -------------I - ---- ------ - -----= Owner t By l-------------= - itle---------------------- -- ----_- _----- -------- --- ---- ,._ - (If'other than ) MENT :USE•,ONL.Y,,c_, APPLICATION ACCEPTED BY --- ------ - ------ -------` DATE -sJ ----:--- ---- DIVISION OF LAND NUMBER_ i ------------ --------= -DATE--------F------ ---- --.- ---- -------------- ADD1TICtNAL CO]ff+11ENTS___. ."`: ------ ------------------------------------------------------ -- ---:------ -------------`--- ------------------------------------------------- 3 h "" ----------- ------------- -------------- ----- ------------- ------------=------------- ---- ----- - - -------\1,---- ----- .-----., _X -_1,. �- ,------- - '------------------------------------ -------- - --- -------------------------------- ----------------------------- --------------- - -- Final Inspection by: --=- Date., EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT ras 21677 Rev. 7/76 3M