77-269 - Laserfiche WebLink

Home Browse Search

PIR OFFICE USE: _ APPLICATION FOR SANITATION PERMIT .................. •--•..... �� Permit No. �..... ......`/ (Complete In Triplicate! w .......-_ 7 This Permit Expir*s 1 Year From Date issued Date Issued . ..... ........ Application is hereby made to the San Joaquin Local Health District for a permit to construct and instal) the work herein described. This application is mode /in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION . f ..�rJr.. . t.f -.F� / �. —.CENSUS TRACT ...... . ................ U �� Owners Name - J' .f� ... .- . G� .ri/ ?.................... Phone �10...... Address _. - V _.... . _.... ._ .. ... .. ...............City .. Contractor's Name ..........................0., .Ge.. �.....................................License ill ........................ Phone .............................. Installation will serve: Residence 0 Apartment H ou Com ercial QTrollw Court 0 Motel 0 Other �� .�' etw Number of living units:.... .... Number of bedrooms ..Garbage Grinder ............ Lot Size ......`.' "�.�... .--- . ................... Water Supply: Public System and name...................................................................._..........................................Private,( Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay 0 Peat❑ Sandy loam❑ Clay Loom ❑ Hardpan❑ Adobe Fill Materlai ............ 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 p#ic� owe is arvoila�le within 240 feet,) 3 .... ......... PACKAGE TREATMENT j J SEPTI NK Size.......,�..�s..... ._r..fd.,?.0 ... Liquid Depth ...... p Capacity Type l-i'.'�.C!na[ moterlal. G'�' No. Compartments ..........---:.....,r Distance to ne est: Well �pla,f.......Foundation `� ....... Prop. Line //...t5K1 .;: 61 LEACHING LINE No. of lines . ... .....-._.-. Length of a line. ... ...... Total Length ../...,�� 'D' Box ... . Type Filter Material ..� ....� aCy�epth Filter Material ..../..� z� .C� .............. Distance to crest: Welt ...l� . ...'. .. Foundation !� Property Line .. SEEPAGE�!!' Depth ---� r .., �(� - umber -.-...._v. Rock Filjed Yes No �[] .t Water Table Depth -------- Rock Size .....111f.z � Distance to nearest: Wel! .../4�� ..................Foundation A t" Prop. Line ..,��aL•• REPAIR/ RDIT1ON(Prev. Sanitation Permit# ............................................ Date .................................. Septic Tank (Specify Requirements) ......---- ---•--------------•-- -----•--.•--- -••-•........�.. ...._.._...............--_........................... ..... Disposal Field (Specify Requirements) •........................... -----------• ----------------- ------------- -------------------------------------------- ------------•---•------------------------.._..................................._....-----............ ....................... ------ ---------------------- ----------------- ----------------............--........................................................................................... (Draw existing and required addition on reverse side) 1 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 11cow sed agents sig re certifies the following: "i certify that n the performance of the k for which this permit Is Issued, I shall not employ any person in such manner as to become ub ct to Workma sation Fad of California." Signed -...- ...1 < ..v....... -`-- f ---------------- Owner 13y ...-.. ----- Title .. ................... (If other than own' ) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .-.--. ,-. . -. DATE . ' ------ -- ------ ................. BUILDING PERMIT ISSUED . . ........ ...... ..... ..• ... . -_.._DA ADDITIONAL COMMENTS -. .. ?. GD - ---- ..........._ ._... .. ---------- ------------ ...-.............................. . ............. ................................... ................ . . . ........ . r Final Inspection by: ..... .. ....... .................. . ..r-------------•- ----- - ------ ... -Date .._. .. ..7�7......-... .-- FH 13 24 1--68 Rev. 5KSAN JOAQUIN LOCAL HEALTH DISTRICT 8/7Ii 3M