78-224 - Laserfiche WebLink

Home Browse Search

' FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT �f - Permit No.._ / (Complete in Triplicate) -------- 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 Regulations: JOB ADDRESS/L CATION_/00 no-• CENSUS TRACT_ �C / - Owner's Name -----�-------�e'1 -----�_QrSF .� ----- -----------------------------------_-----------Phone--4/.7 Address------------------Zo----------------C4-,e noxi gyp, �'r�+ T-- -l'--7--------------------------City-------c� 1-� (1�R.�-----------Zi Contractor's Name6v� �-o_____ S ` '�- License #__.3 , I-----Phone_ 63 _-___- Installation will serve: ResidencqA+--`A'partment House.❑ Commercial ❑ Trailer Court ❑ Motel ❑,' Other.------------------------ Number of living units:____ftX-------Number of bedrooms__„3---Garbage Grinder------------Lot Size--------- _oc.�-_3______.___.___:_____ 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_______________-__.________ (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 sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK H--__ Size___.X_�.._X__!_O.'_ Q� 1 +►d �� ,,� ------_-__--Liquid Depth-_.�S--------------- Capacity__1�Q_OU-----Type---Jam._-=-__-.Material___0�•___-______No. Compartments_____�__.______________-__- ' ( i Distance to nearest: Well... '._._ ?d_____-____-Foundation_.-.-tax_.-.._____Prop ine___�?_�.____...____.� LEACHING LINE No. of Lines..... -_______...Length of each line_._._ -_ g O_ -_------- _--- Z_ / ------------- /- ------------Total Length ---..�_ �/ 'D' Box__/V_`ti'ype Filter Mater* I__/4_�ZL epth Filter Material__._,--(.-_-.-_ Distance to nearest: Well--- -------------- --__ ______-Foundation____A=X-u_-- - ---------.Property Line------ - - -----------------------Q SEEPAGE PIT Z4/ Depth_v7s-----Diameter__=---------Number--------2 ----------------- Rock Filled Yes 8... No ❑ Water Table Depth-------� ----------------------------------------Rock Size---------- --------------------------- Distancetonearest: Well__/--&7®________..-___-_.________Foundation__8 -/_.___-___.Prop. Line___________________ REPAIR/ADDITION (Prev. Sanitation Permit#.:.______________.________--___.______________Date___-_.___________.________.__._______._____) Septic Tank (Specify Requirements) - - - - - Disposal Field (Specify Requirements)---------------------- ---- ------------------------- ------------------------------------I--------------------------------------------------- ---------------- (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 subjectWorkm 's Compensation laws of California." Signed------------ --- ---- ---- Owner g1� By------------- ---- ---- -- ---- -----------------------------------------------------Title--AerGt.--- ----414S5 �Q (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-----) ------------------- -- - ----- - -------------------- ------------------------DATE.---- DIVISIONOF LAND NUMBER--------------------------------------- - -------------------------------------------DATE-------------------- ------ ADDITIONAL COMMENTS - - - ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ --------------------------------------------------------------------------------------------- -------------------------------------- ---- -------------------------- ----- ------ ---- ------------------------- - ----------------------------------- - - - - - - -- Final Inspection b ,�.__ .__ _ __._ Date___.-. - __�� ('_-_. p y:-.--- -- .fit — ' EH 13 24 SAN LOCAL HEALTH DISTRICT Fos 21677 REV. �i�b,2A