78-600 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE- APPLICATION YI N PERMIT APPLICATION POR SANM.A O 6 ....... .. ............................... Permit No. .................... iCompiete in Triplicate} -•............................... 7/l`- 7� ------------------ i This Permit Expires 1 Year From Date Issued Date Issue ................ .... Application is hereby made to the San Joaquin Local Health District for a per 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/LOCATION � _�`_ � ..:^.f�1._�i:�, d..4rYt .-!�• •.•. ..CENSUS TRACT .............. Owner's Name ._.......�j.6-FZ. .. T �(1 ... !T�-�J---..q..:.. one ....:................. Address'._..... A. �=.............. ...... .................. ...:.... City .RA 4N. 7?tA...............::.-•--:.:_...................... Contractor's Name ../Ill ' . ......................................License #,V157�'.i;...�--•-."Phone .....�.��.... ... . . Installation will serve: Residence ❑Apartment House Commercial ❑Trailer Court 0 - Motel ❑Other 1 -" Number of living units:.____._ Number of bedrooms _ Gar age Grinder ............ tot Size . 1��.....t�---,----••--••-•: Water Supply: Public System and name .................=............••-••.......................__....... ..........................................,Private Character of soil to a depth of 3 feet: Sand n Silt 0 Clay ❑ Peat❑ Sandy Loam v Clay Loam D � .4 ""`r. Hardpan ❑ Adobe`'❑ -Fi�il Material _._•........'I#yes, pe .._:. (Plot plan, showing size of lot, location .afr system in relation oto=::wells, buildings, etc. must be placed.on, reverse side.] 1v NEW INSTALLATION: 1No septic tank or seepoge'pit permitted if public sewer is available within 20.0 feet,] 4 PACKAGE TREATMENT { ] SEPTIC TANK-[-]..' I size..... . ................... Liquid Depth „� ._.;_.._.._ o4 .�.` ,k Capacity .......Type f 4_ Material...................:.. No. Compartments ...... ..... ... a a �7 � Distance to nearest: Well ... --'----• _.Foundation ............... Prop. Line G?_`:" ......._. K LEACHING LINT~ I j t No: of Lines ....J........... '. Length of each line..... ... ... ........ Total Length .. ...................... . Typefilter Material ../_ _A_Dbpth Filter- Material .... ................. Distance to nearest:-Wali ..rV....::........ foundations __.........._.. Property Line ==----: SEEPAGE-PIT ( Depth ._...._..._., :,~Diameter -- ....... Number _............______•......... Rock Filled.: Yes n• -,No'Q ` Water Table.Depth ..............Rock Size Distance to nearest: Well ,_.._`......:.. .._.Foundation . Prop. Line REPAIR/ADDITION(Prev. Sanitation Permit#` 1 �:.__:.z.: _.._ Date ... ..] Septic Tank (Specify Requirements) _..... ._177A�V. �------1.4°.- � ------------- ....-- C• 'yC�� ,...!_.... .... ...__ -� �-� �- Disposal field ISpe 'fy"Requirements] __.... 1 � ..... Y • i -0 ____ _________________ .___--_--_-________........_______.-____._.w_..___.____.....____.__.........- . _. -----._.._...... --- (Dra -existing and required addition on reverse side) / �l I hereby certify-thatI have prepared.this application and-that,the work will be done in accordance with San Joaquin County Ordinances,.State Lcws,'and Rules and Regulations of the San Joaquin Local'Health District:donne owner or licen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person In such manner as to become subjec o rkmdn's ompensation, laws of California." � Sinned ---- - . ------•-••-------•------------- ---• Owner .. s By ............................................ --------....................=.................................... ..... Title ------ --.._.. ---------------------- .................................... (If other than owner) w FO EI'ARTMENT USE ONLY APPLICATION ACCEPTED BY •:.. .. ... .... .• ... ......................... ._...-----•----.. ..................... DATE .....7 � BUILDING PERMIT ISSUED_..._-' ...... .....:.DATE ..............I...._ ---.........••... .............. ADDITIONALCOMMENTS ::------------------•-....----....................--•.-... -------•••-•-•••----- ..................................................................--••=-•---- - ---------•------ . ......................•••---- ............ ...... . --••-••-•-------•-•-- ....._...-- _ = -•....... ............... Final Inspection by: .._:._ J ...............••-••• . .........Date .. :7n .:7- � -... SAN JOAQU LOCAL HEALTA_DISTRICT c u 13 241-1,40 De.. SAA - - 7-/723-,A _