77-567 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE; FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ,' -0--------- Permit No._7.7`57 a * / (Complete in Triplicate) �f! --- ------------------ Date Issued--_7'191--77 ._----------_________._.--.------------__--_----_-------- This Permit Expires 1 Year From Date Issued , Application is hereby made to the San Joaquin'Local Health district fo`r:apermit-to-construct and install the work herein described. This application is made in compliance with Count-,y Ord'inanc'e No. 549 and'existing Rules and Regulations: . { CATION , - �. --- � - - --.CENSUS TRACT JOB ADDRESS/LOO _ r�--_ - Owner's Name. ' - �41' laz -_.- > i ---- --- Phone :307.a' Address � �.� ---.-�;: Ci Zip ' Contractors Name------------ -�� t9-An e - & -�1(4 License# �� -_.-Phone , 6�, °---. > is } �. -. ..!�... Installation will serve: Residence Apartment House 0 �C_o•mmercial ❑ Trailer CourtV❑ i' Motel'-❑ tOthe. `-- ------ ------------------------- Number ------ ---Number of living.units _- -Number,of ----------- LotSize----. `--. .....-.K- /-0-7 -------- -- Water Su I Public S sit m and name- -_------- r, -- s �( i s --- �in !-- - ---- -------- ----Private ❑HardpaAdobe F,ilt❑ Clay Q --Peat ❑ y Loam []w Clay Loam ❑f soil to a de .th of feet: s Sand Character of t�r'l`3" ill Mater�al.a ---'----.If-yes;aype----------------------- I (Plot plan, showing size of lot, location of system in relation to wells, buildings;etc.'m0st"be placed on reverse side.) NEW INSTALLATION: `(No„septic task. or seeppge ;pit permitted"if public sewer is ova 1p6le within 200 feet,) , [ ] [ 1 - - - ------Liquid Depti--------- ------ , PACKAGE TREATMENT � � � SEPTIC-.TANK-[j1----+•' `�- �''Size----'------------------------------- _ t'- --------� ;. ¢' Capacity:-'- `.-=' - = '-Type-----; "- :" :-Material _-.- - No.Compartments ' "--------------------'-- a Distance to nearest: Well --------------'-_--- - Foundation_ ..Prop. .L.ine-- ---'--------------- No. - --- LINE [ ] No, of Lines_T_________---:{_ -.Length of each li6a•______, -__ --- -. =... Total Length ------------------------------------- LEACHING _-� - i 'D' Box-- _ -_-,Type Filter Mate ial.-- •- ----- --'Depth Filter Mater;ial_-_------------------- - ---'---------------------i----- , . ----1. - ----- --- Distance to nearest: Welhf----_-.---- - _Foundation_---_-_-__.____ _.Property Line__- : - SEEPAGE PIT [ ] Depth____ ______ ____D.iam€ter_ Number----------- ---------------------- i Rock Filled . Yes F] No f -------- --- ---- .- -------------------- 0 --- ------------- • Water Table Depth.---:--- ' = Rock Size ' - ' I Foundation Distance to nearest: Well- -- -- ---------------------- --- Prop, Line--------= ------ 'Ile t REPAIR/ADDITION (Prev. Sanitation Permit#-_.---_------�,- ---_-_-- ---------------------• Date.---•-`------:-----'------ `-`-----; ----) 1 n Septic Tank (Specify:Requirements)---- !------ -- ------------=------------ ! --- -- ---------------------- 0 Dis'posaI Field (Specify Requirements) - = = - ----------- --- '-ft= ------------------------- --- - ------- ------------ ------- :: ------ - --- ---- _ -- ------ - ------ -=-- q = = - 4. T (Draw existin and're wired addition an reverse side) i I hereby certify thata have prepared .this application'ipnd 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 perfor nce of'the work-for which this permit is issued, I shall not employ'any" person in,such manner as to become subject t n's..Comperis laws oal' ornia.':- Signed-- - - - ``� Owner T _- ---------- = = ------- `.."'. ----------- By-1i - r Title- - w ¢ (If ofher'than'.pwneF) .;' FOR DEPARTMENT USE ONLY ` APPLICATION ACCEPTED BY-=------" - -- - -- - --- -=-----=-------==-------'---`- -------------=------DATE.-----7 ---------------- DIVISION -,-------:--DIVISION OF LAND NUMBER.------=------------- I-----=-----'---------------------- ----=----7--------`'--- - - '-----------:---------DATE------- --- ----.--- -------a.------------------ ADDITIONALCOMMENTS-----------------------'------------------------------------=-------------------------------- --- ------------------------------------- ---- ------------------------- ----- . ------------------------- -------- ----- :.. ------ ---------------------------------------------------- --------------------------S -----------------------------------------------------------•---- ----------------- -- --------- ------------=-------------------------- _ _ _ ------------------------------------- Final Inspection.b ' `' ' = pate ---.=b} - .. Z7RI�V. ------------- - ------------ ----------- EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT Fes zi67/76 3M }