78-872 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: Y FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT pTriplicate) Permit ----��a ^------- - --- ------ --- ----- ---- (Com tete in t Date Issued_/p.-/D--=�o' „__,_-------_--- -- _---___-.-- 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 complli'ance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION-------�b ---------- - ------------------ ------------------------------ -------CENSUS TRACT----- -------------------------- Owner's Name----------------- L,_,--- Address ,/ -- - Phone__1'3�� Address---------------- --- d-b I-7 _ ---------------------------------------City-- - -----------------Zip-------.----------------- Contractor's Name.. t� _ -------------License #Z�(-� 3-----Phone----V-- -- b.�-7----- ----- ---- ----- - - -- ----------- Installation will serve: Residence Apartment House E] Commercial F1 Trailer Court E]Motel ❑ Other- --------- --- _ -- ----- / Number of living units:--_ --.__Number of bedroom s----�- Garbage'Grindev------------Lot Size-- _46___?�_f-(P--� ------- Water Supply: Public System and name----------------------------------------------------- ----------------- --------------------------------------------Private Character of soil to a depths feet:, Sand ❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe'l Fill Material--_--------If yes, type-___________--------------- HCl (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) .J NEW INSTALLATION: (No septic tank or seepage pit,permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK [ ] _,._ ___ . . Size----------------------------------------------------------Liquid Depth.------------------------- -� Capacity--------------------Type------ ---------------Material--------------------------No. Compartments--------------------------------- Distance to nearest:Wel l-------------------------------------------Foundation--------------------------Prop. Line_._______.___--____.-.__.--- LEACHING LINE [ ] No. of Lines____________________________'Length of each line._______-__.____--_______..Total Length.---------------------------------------- 'D' Box------------Type Filter Material--------------------Depth Filter Material-------------------.-------------------------------------------- Distance to nearest: Well--------_-------------------Foundation-----------.----------------Property Line-:______-_____.__.___.__.__.--. SEEPAGE PIT [ ] Depth----------------Diarweter---------------------Number-------------------------------- Rock Filled Yes ❑ No ❑ __ - _ __. Water Table Depth ------------------------Rock Size------------------------------------------------ bisttince to nearest: Well------------------------------ __-------- p ___..Foundation.._-____.... __-Pro • Line_______________________--. REPAIR/ADDITION (P`rev. Sanitation-ermit#_: -----_. '� -- ------ ---- - --- - --------.Date---------------------------------------------- Septic --------- ------ ---- ---..---- Septic Tank (Specify Requirements)----- - - - - - --- Disposal Field(Specify Requirements).. ..:. -- .._ - -------- ----- -- -- - - - l� --------------t----------------------- --------------------- ---- )c--- ' ---------------------------------------------------------------- -------=----- ---------- ---------- --------------------------------------------------------------------------------- ---- -(Draw existing and required addition on reverse side) I hereby certify that I have preparo this app ica `ori 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 HeW*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 subject to,Workman's Compensation laws of California." Signed a = - Owner < A w r 4 v BY- �/2-'-�-�------ - -------- -- - - - - - --------- --- -------------- --------Title-- ------ ---------------------------------------------------------- (If --- --------- ------- - ------ - ------------- (If other than owner) OR EPART S LY APPLICATION ACCEPTED BY------- ------------------------ DATE.--- ---- - _. ---- ------------- DIVISION OF LAND NUMBER.------------------------ - DATE - ADDITIONALCOMMENTS--------------------------- ---------------------------------------- --------------------------------------------------------------------------------------------- - - - ---- - --- - - -- - - -- --- - -- xn �4hyk .: ------ t_� ----------- �--- ----Q� ---- Final ____ * • '-�11 p _ - Inspectionby: ps i --------- -------------- ------------------------------------- -------Date---- -©_------------------------------------- EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&s 21677 REV. 7/76 3M