79-371 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: FOR OFFICE USE: ~ APPLICATION FOR SANITATION PERMIT ,�, Permit No.79."�,3: J. (Complete in Triplicate) O`fi ----------------------------------------- --------------- N Date Issued,,5-9..... .. .- ............................. This Permit Expires 1 Year From Date Issued Application is hereby made to-the San Joaquin Local Health District for dpermit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: j [JrZ15 8CC AAIB CENSUS TRACT........ JOB ADDRESS/LOCATION.................. ..._...-. �4f.S Flee,-, qAt Owner's Name.... ..... ..........------- ..... Phone.. Address... �, a� 9 Z9� 'T7 -,'i.Aavi 6R Cit �� ,Zip-------a---- -----•--.:. y... :--- C � LIQ.......... License # "1!Q Phone- ---------��-$Y-.... Contractor's Name...... ... ------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other_- -- ------------------11 ---- p - Number of living units:_._J _.......Number of bedrooms-_.3-----Garbage Grinder.......=----Lot Size.......1"---/�...... ------ . Water Supply: Public System and name_:" -----•---- ---------- ................. ----------•- ....... ---•----.-- ------ Character of soil to a depth of 3 feet: Sand 5d Silt❑ Clay ❑ Peat ❑ Sandy Loam ❑ �' Clay Loam ❑ Hardpan ❑ Adobe ❑ " Fill Material.. .... ....If yes,,type_-:-::..--- ... {Plat plan, showing size of lot, location of system in relation to wells, buildings, etc. must be pldced'on reverse side.) A! NEW INSTALLATION: (No 'septic tank or seepagepit permitted if public sewer is available within 200 feet,) V 41 1/z PACKAGE TREATMENT [ j SEPTIC TANK [ ) �, Size.... ----------Liquid � .Dep#h-------- ----- -- ." -- - Capacity.- ZOO. rial. --------------- ��Te--. Distance to nearest: Well_-.---.-!Vu.t^=rte..-- --"--_- ----Found tion........ . .......'Prop. Line.......... ---.-.----. N LEACHING LINE [ ) No.of Lines ----. ---------------- gth-�.of ach line.------7 -.-------- ---Total Length -. .-.2l . Len - Bo,.._r+........Type Filter Materic11 li/.L.-......Deptf(Filter Material.......l.1..�_--"-----------------............ .*Y 101 Dis#once to nearest: Well----..-�.��...-- ----.Founds ion.------_------------------Property Line-----�-----.--.----.----- -- SEEPAGE PIT [ 1 Depth................Diameter-------- ......Number ---------.---- Rock Filled Yes ❑ No Water Table,Depth------- ---------- - ------------Rock Size-- .. . --------- 21 Distance to nedrest: Well-/---------------`------------- --•---Foundation-.------_.------.- -.....Prop. Line.------- .---------......- . y,p ' REPAIR/ADDITION (Prev. Sanitation Permit -------------------------- -"-- -- -------Date_-------.....-------------------- --1 Septic Tank (Specify Requirements)---- - -- Disposal Field (Specify Requirements)--------------=------- - ------ ---------------------- -•------•--------- ------ ---------------------- _ --------- (Draw existinig 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. Hoene owner or licensed agents signature certifies the following: l "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 Competes on laws of California." Signed....-r^fes.. , ----.-... ............ -------------- -- - ----- --------Owner 1 ....Title--- ..._ ........ •---- (If other than!oed l FQR DEPApjftMENT USE ONLY APPLICATION ACCEPTED BY........ - - -Y-- ----- ------ ------ DATE - -- --`--- ....... ... . ............ DIVISION OF LAND NUMBER--- ------------- - - _DATE.------- ... ......--.. ADDITIONAL COMMENTS--------------_--- ----- ...... -- ------------------------ .... :.. ---- --------------------------•------------ -------------------- -------- � Fina! Inspection b Date.......... � ' -----•------ -- EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT ras ere» Rev. 7176 3