79-337 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: JFOR OFFICE USE: ------------------------------------------------------ APPLICATION.FOR SANITATION PERMITPermit No.7.9_ _'33.7 (Complete in Triplicate) --------------------- -- - 1 1� � � Date Issued��..�1_�?_-L__ .________._______ _ A------------------------ _ 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/LOC N `` �__.- . : -- ----' :rt =------ --- --�---------.CENSUS TRACT--- ��! Owners Name._._ ---- ------------ --- - -------------- hone-' ---- -:- --_. J Address ' = ---------- City Cortractor's Name--- Installation ame - - ------- -.License.#3+ �'`�? Phone- Installation will--serve: i Residence,( Apartment House.E] Commercial ❑ "Trailer Court. ❑ . : [) ': Other-- ---- -------------- Motel - '' " } `� ,.. . . . ,,.... r t - / t L ! edrooms;.-3:____Garbage Grinder_.____._.___Lot Size-- 'Z"- :"..-"" Nu ebe f living:Pubinct5 em and'name-.-.-' Wat Supply-. Y - _ - - .. .--- ---------- ---- --------------- Pnvat e.®� Character of soil to.a de pth*�of-'3 feet: : Sand Silt -ClayPeat Sand Loam ClayLoam Hardpan ❑ Adobe❑ Fill Mate --------If yes, type__.__._______________. _ t ------ (Plot plan, showing size of lot bcation of system in relation to,wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No. septic tank`or seepage .pit permitted if publitpwer is available within 200 feet,) tY X� - � os•.r Liquid Depth.; �� s PACKAGE TREATMENT [ ] : SEPTICZANK � Size.._____ J------- f Ca acit i�cpv.. . p' Y' TYPe r '---- --Material_.__ Q __�..,_No. Compartments = l � > 0� Distance toinearest,Wel - .lZ®.____ Foundation .___ u __._:.__Prop. Line t '___. LEACHING LINE, [-�-! ,Na. of Lines_, ,3------ .'Le_ngth_of each line -_ ..�dt--------------Total Length --------- _ rL.JrA ' Box./--j- Type filter MateriaLl__! "� "Depth filter Material____ ------------------------------------------------------- D r ... _ t + Distances tonearest WeIL.__ �_d----- _____Foundation_.__ S __:.__Property Line c -� �- ., F' /—fr---�--�--m b %SEEPAGE PIT [ Depth.Z I Diameter '_ _.. _ Number -3-____ € - Rock Filled Yeses No ❑ Water Table:Depth ---- - -- _ �� - """ Rock Size.__ _ _ 6 . ._ / Distanceao nearest: Well_..__ __.'__-- ✓r-------------:Foundation--'------_------------=_.Prop. Line---------------:----------- e _- .i t-REPAIR/ADDITION (Prey: Sanitation Permit# -_ =---=---------'__-= =-----Date_._.__:_:_- `----------:--------------- '"----I Septic Tank (Specify Requirement ' "- -------- --------ti Dis osal Field (Specify Re uirements)' t , fi_- 0--- --- ----- - - ------ k -- :_�-------- ----------------------- -. T - I . (p.raw,existing.and required addition on reverse side) hereby certify that 1 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 ofthe work for which this permit is'issued, I shall not employ any person in such manner as to become subject to Workm n's_Compensation laws afx California." - i 5 `'- ),k ��- O - = Signed-------'- -- - / -- - -- ----- - --- ;. . :. . . � ---------------.. weer .. - k -�! -------- -- &MOZICre- ---- _,eve---- (if other than owner} '' F s FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BYPB'L.C,� - ' --------- ---------- -- -----DATE 2 ---- DIVISION OF LAND i NUMBER.. " DATE - ADDITIONAL COMMENTS------------------- ----------------------------------------------'----- -------------------=------------------------------- ----------------------------,---- -- _. ------------- ---------- -- ' . . --- ---------------- - = „ -�- ------Date - - ----- ------ ----- ----------------- Final Inspection by:-- --------- --------------------------- ------------ EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&s 21577 REV,7/76 3M d_ r