78-656 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: FOR OFFICE USE: w ..7-79 APPLICATION FOR SANITATION PERMIT - ._..- ..---• G� � (Complete-in Triplicate) � Permit No.," /, - -'� ----1P..-- � N, Date lssued..��:7�_7� ki ................................. --------------------- This Permit Expires 1 Year From Date Issued F 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./Q:w ----------------------------CENSUS TRACT............-................... / ) Owner's Name ......... ............... .... - ........i--- ..Phone._-;:�f _-_ ._ ..........- Address-._- a /3 �� city S 3G ' Contractor's Name._.... ..... ----------- - ............ :.License # ��.5 1 ._. .Phone.------...--------- ....... f Installation will serve: Residence ❑ Apartment House Commercial ❑ Trailer Court ❑ Motel ❑ Other..... - ------------------- --- - { Number of living units:. ` _-Number of bedrooms: Garbage Grinder Lot Size .... t------•-- ......... Water Supply: Public System and name ----------------•-1--------- ---•---•--•----.------- Private' Character of`soil`to a depth of 3 feet: San o e ❑d Silt ❑ ' Cldy-0 Peat ❑ ` Sandy Loam f] Clay Loam❑—""'`. Hardpan E] AdFill Material.. .... _:Af yes, type__________________ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) 1 NEW INSTALLATION: (No septic tank or seepage pit permitted if �public sewer i� avail le within 200 feet,) � Q PACKAGE TREATMENT [ } SEPTIC TANK Size . 7 1-� `-../ Depth ----------------� I' w`�� Capacity i ��A�-------TYpe-- �- . _: ...Matexidl_ ----i--No. Compar'tmeri#��-----•-•-�'"' ..-..'...- Distance to nearest: Well___ --...'-..... .. .........Foundatign..` l� . -....,4....:Prop. Line.-. ..._- --.�` LINE [L}%No. of Lines .-.___. -._-__-_---__.Length of ach hne.�------------------ LEACHING 7�.-�.Total Length - ' $�-'. ` .i { D' Box-_...Type Filter Material- {. - .4.4- - .Depth Filter Material-..._.. ____ ___________________ ________ Distance.to nearest:Well< --�-Q-___-- ---._.Foundation--./Q----------------- Property Line...... -- - -- --'�!--.--------. T [ � Depth_.14)...'...Diame-te -__ O' ��..Number-_----.. ___________________ ,� ��Rock Filled Yes [G�fNo Water Table Depth---------- ------- - - ---- Rock Size )�.3.. l e Distance to nearest: Well/. 66.. . _------- --------Foundation....X4.............Prop. Line.... REPAIR/ADDITION {Prev. Sanitation Permit#--------------------------- ------- ......---------Date._..........------------ --- ..--.--..------) Septic Tank (Specify Requirements)---.; .--• - - -------------•-----•------------ I—— -------------- - ---------------- Disposal Field (Specify Requirements)- -•-•------•-=-- -•----------- - - -----------------------...----------------- -- -------- ---------•------------------ .......... - �- - ------------- -- --=-------------- :. (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 r signature certifies the following: "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner as to beco a bj et to Wo an's ompensation laws of California." Signed_._.- -... .. .�. - --------- ----Owner BY-•------ ---------_------------------ Title. - ------ (If other than owner[ F PA MENT S NLY APPLICATION ACCEPTED BY - ... --- - - - --- DATE . .. -..-. DIVISION OF LAND NUMBER. ----- - ------ - DATE ...... _/------ - ------------- ADDITIONAL COMMENTS.................. .......... --....-.... ..... -••-------------------- ------------------ ------...------. -------- ....................... ......... ..... ........ q .__-_._.__._.__------------------ .................. ---------------------------------------------------------------------------------------------------------------------------------------------------- ______________________________________ _._.._ ..---...____...--. _ ___..._- -.______-.._-_----_-.._...._.___._-__-...__--____-_-__--------__---___-- ,4 ---Date Final Inspection by:..--��.�.. .- -- ��'��/� rAQUIN ------------- -------------------------------------- EH 13 24 SAN LOCAL HEALTH DISTRICT01 21677 REV. 7/74