77-323 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: OR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No.__7_________________ ------------------- ------------------------- , yo 77 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/LOCATION /4 ------------- !`-Y-------------------------------------CENSUS TRACT--------------------------------- Owner's Name------ o A_-__._--/ - CLG - ------------------------------------ -- - ------------------------Phone-� ----776-------- Address---- ------ 4F -------------- ---- City - - -----Z'p----------------------------- Contractor's Name------- 4----------------------- --------------------------------------------License #--------------------------Phone---------------------------------- Installation will wave: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other---------------- ----------- Number of living units:----------------Number of bedrooms._.-3---.Garbage Grinder------------Lot Size_________________________._-._______.__,.____________ 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.) -00, NEW INSTALLATION: (No septic tank or seepage pit permitted if publi sewer is available wit in 200 feet,) 4 PACKAGE TREATMENT [ ] SEPTIC TANK X1 is � -------(_ VAX */f /)Liquid Depth-. -_-__--_ Capacity---------------------TYPe---------------------Material--------------------------No. Compartments-------------------------------e, Distance to nearest: Well-------------------------------------------Foundation--------------------------Prop. Line___-______--_..._._._----. LEACHING LRNE [ ] No. of Lines-----------------------.-----Length of each line.------------------------------Total Length...-_-----___________________-_-- Y E)CIS7-1/1/CN� 'D' Box------------Type Filter Material--------------------Depth Filter Material______________.---.-____-_-__________.__---.____________� Distance to nearest: Well .___--..__.--__.___..--Foundation-----------------------------Property Line-------------------.__-______- SEEPAGE PIT [ ] Depth----------------Diameter______________.__Number ---_-______- Rock Filled Yes E] No [� Wer Tabl De th---------------------- /-- Size------------------------------------------------ an / /Q X Distto nearest: Well------ Line.______.-.'7114.--------- REPAIR/ADDITION (Prev. Sanitation Permit#__________________________________________________.Date__________________----____----. ) Septic Tank (Specify Requirements)----- ------------- -----v--/----------y-fi--------------.c"y;e ----- �i17e A----_ ------------- ------ ---------- -- Disposal Field (Specify Requirements)._--.-_-----.l____ .,T{__,�_____ '\___________' -_-__.-_-__------ - -- -- a -----•-------------------------------------------------------------------------------------- -- ------------------------------- ------------------------------------------------------ A,AN (Draw exisfing and required addition on reverse side) I hereby certify that I have p pared 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: N certify that in the performancepf the work for w�ich this permit is issued, I shall not employ any person in such manner as to become su tAr k Compensation Jaws of California." Signed-°4 ---------------------------------------------Owner - - ------ -- By --- ----- - ---- a t ----r --:--------------------------.Title ------- (If other than q�vner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - - - - - - --- ----- ------- DATE.---470.- - ATE 'Y� ---------- DIVISION OF LAND NUMBER-------------------- _ -_-----------------------------------------.DATE---------------------------- ADDITIONAL COMMENTS_ - ---------------------------=----- ---------------------- ------ - - -- - - ------ ----- ----- --------------------- -- ---- _ �_. ------------------------- -------------------------------- _ -- ------- - ---- - ------ c -- - ------- -- -- -- Final Inspection by --- -------------T-_-- --------------------- -- -D E--------------------- EH -- EH 13 24 SAN JOAQUIN LOCALHEALTH DISTRICT F&s 21677 REV. 7/76 3M