78-824 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: FOR OFFICE USE: ��_ P� -- /APPLICATION FOR SANITATION PERMIT ------- / -- ----- - - �j Permit No._T - �1 r -_1� 4 �j�„/ (Complete in Triplicate) Date Issued__�_-a- _,_?r -4Y4 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: �J JOB ADDRESS/LOCATI N--- �--`._--�.--- .-+-------6a/� -----.��1 t---:-i '"C�NSUS TRACT------------------ Owner's Name. - "� - Phone_ .Z..�.�.�-- �j �, R --- -�-- /-------- ---- ---- ---- -��.�-fit-- - ---- --- --------- - ------- City - - ---- --- --------- ---------ZiP------------------------------ AddressContractor's Name s t -Lc_,[----- -s��'_-�.�4- ___-[ �_�-7�----7-_ ag -�____�•'2V�.___License #--__ l- Installation will serve: Residence).( Apartment House.❑ Commercial ❑ Trailer Court ❑ otel ❑ Other------- ----------- ------------- Number of living units:------!__-------Number of b rooms_ _____Garbage Grinder_ _Lot Size------ ------____,____.___---- ___------------- Water Supply: Public System and name._..-_ ----------------------------------- --------------------------------------Private :L�c Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ -Clay Loam ❑ Hardpan ❑ Adobe X Fill Material_.----------If yes, type---------------------- W (Plot plan, showing size of.lot, location of system in relation to wells, buildings,etc. must be placed on reverse side.) UA NEW INSTALLATION: -. (No septic tank or seepage pig per hied if ublic sewer is available within 200 feet,) _Z*_ PACKAGE TREATMENT [ ] SEPTIC TANK [ ] � ize _______Liquid Depth_-------------------------- Capacity-. _ ________- -- ----- --- ------- -------- --------- Capacity-.----------------Type---------------------Material---- ------------------No. Compartments ------------ Distance to nearest: Well ---- -- - - --- - _____ Foundation.--------------------------Prop. Line--.__c _ ----5 - LEACHING LINE �j° No. of Lines____ ! -------------- Length of each line ___�'_ _�-_____ . _ Total Length ____ . _..___.. ,/ ---------- -Y, 'D' Box l-----Type Filter Material_ It .-Depth Fi{ter Material.___. __ --_--- Distanceto nearest: Well------ _____ Y---FoundX _ a.___ . - Property Line _ ------------------------ SEEPAGE _ - _.____. SEEPAGE PIT ( Depth_��------Diameter_ 7 -_______--Number_____ _____ ____ ____ Rock Filled Yes No ❑ ,/ r' �- Water Table Depth. - ---_-- -------- - --- ---- - ----Rock Slie ---.---------------------- Distance - ----- Distance to nearest: Well___,t10 _FoUQ&tion----1010... _..Prop. Line_''`_----------- REPAIR/ADDITION ____ _REPAIR/ADDITION (Prev. Sanitation Permit#----------------------------------------------------Date-------------'------------------------------.) Septic Tank (Specify Requirements) G` -_"� Disposal Field (Speci y R quirement )s_ ------- ------ ------ -------------- -- ivy -- - --- -- --------------------------------------------------------- ---------------------------------------------------------'--- ------------------- ------------------------------------------------------------------- (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 n`of employ'dny person in such manner as to become subject to Workman's Compensation laws of California." Signed________ ___ GLARENCE'S SEPTIC & SEWER SERVICE c ------------ ---- '- Owner 263 So. Oro vL Stockton, Calif. 95205 ----------------- By------ ------ --------------- itle------Ph,-463-32G%----1c�±�lrrx-tot's-L-tc.1 2671-71--------- (if.other than owne R D ARTM E ONLY APPLICATION ACCEPTED BY--------- - - ----ll-- - ear DATE a 7 --- ------------------ DIVISION OF LAND NUMBER---------------------------- .___DATE_..-________________ _ ADDITIONAL COMMENTS f=�Z6- f' ' o�C _� _ t6c -__!_�• f,,_,, 7,ham'` - _ ------ ------ ------- -------- = �- � ----- _ , ---------------------------------------- ---------- --------------------------------------I------------------•-------------------- -- - -- --- �� -- -- --- --- ----- -- -- ----- o -- Inspection by: Fes-`---- ------ -- ------- ----- ------------- - - ----- _ Date-- 9- 02 7--------------- Final � EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&s 21677