77-768 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: - - FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT - ------------------------------------------------------- I� (Complete in Triplicate) Permit Date Issued_.= _"77 ----------------------------------------------------_-_ This Permit Expires 1 Year From Date Issued I� 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....C _, - - .----. - '--------------------------- - ------------ CEN TRACT- ... ------ �- ` '` US OAddress_ Nam l� -_-Q_-,_ c�,� Phone----------------------- ------ --=- G /.Y` - - ----- City P le .# ----- - --------------------- --- --- ---- -- ------ Contractor's Name----"�-` ------- 1 7 License - ----- ------ ------ ----------------------- Phone-i = ------- - H Installation:will serve: Residence ❑ Apartment House-E] Commercial ❑ Trailer Court ❑ �� [. .., .-Motel ❑ Other- _ Number of living units:-____ _Ih Number of bedrooms_;__------Garbage Grinder.__:_-___ _Lo Size_-__._ "_________________ _----"---_-___, N Water Supply: Public System and name .< --- -.. ' ::--:. .. . ------------------- �feet. _ PrivateCharacter of soil to a depth of Sand ❑ Silt❑ ,Clay ❑�-^Peat-[!j -^-Sandy Loam ❑ Clay Loam ❑ F F Hardpan ❑ Adobe W Fill Material._..-------- _ If yes, type'_._____-____ __________________ (Plot plan, showing size of lot, II cation of system in relation to wells, buildings, etc..must be placed on reverse side.) NEW INSTALLATION:` ]No septic tank or seepage, pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TAN K" ["] Size__" --- Liquid Depth `.___--__-__ -- ----------- R Capacity._-L �!Q _ TYPe aterral___-':-_-' -_ . - No, Compartments___.____v�--__.________---F---- Distance,to nearest: Well_,,��__`�,_F_Z --1GfouncTat"ion:____Y._Lf— Prop. Line___1�-, _� LEACHING LINE. [ ] No. of (Lines.:_-- g gD ___,___. ; :Len th of each line ;____._.____.Total Len th.__. __._ D' Box€r ___...Type Filter Material,_ .-• } t Depth Filter Material-------�--d--- r'"t.------------------- ------ -- �c�i � Distant to nearest: Well __ �Qoundatton_._------------------------ < _.Property Line___- --------------------------- SEEPAGE _ f SEEPAGE PIT [ ] Depth__-�_.._ [___ Diameter + _:__ Number...`------------------- _ i Rock Filled Yes ❑ No ❑ Water Table-Depth--.------------------ ----- '----.Rock Distance to nearest: Well---------------------=-tr__z=__z--- Foundation-------- -----"Prop. Line---------------------------- REPAIR/ADDITION ------.------- ----.REPAIR/ADDITION (Prey: Sanitation Per_mit#_____________I ___(___-_ _._'__ _ '" _ --_--- _____"__'----- Septic ___ Se tic Tank.(S(Specify Re utrements) _----------- _.- _.___ -_ __ _ 'isposa Field (Specify Requirements) r,_•--'---------- -----------------) -- + - _ -- - --- ------------------------------------ -------!------ -- t" -`� {Draw existin and re ulre'd'addition—on s1de� i I hereby certify that I have�prepared..this-application and that the work#will be done 9n accordance with'. San Joaquin County Ordinances, State Laws;-and Rules and Regulations of the San Joaquin Local`Health DisfriEt. Home owner or licensed agents signature certifies the following.mo "I tern that in the I 6 I 1 ) certify performance of work for which this per is issued, I shall not employ any person in such manner as to become su lett to Workman's Compensation laws of California." � Signed f - - - i• . Vnr By' ------ ----=-----------------'--- ------=---- - Title ' -- (If other than owner) F .. I ' ' FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY......l - - - — - - _ --- = .._..DATE----- =_ ::. DIVISION OF LAND NUMBER 1M . / q. f: _DATE------------- = ADDITIONAL COMMENTS__: it ' ------------------ ------------------------------- ------------ -------------------------- ---------- ------------------------- --------------- -"----------------------------------------- ► 1� p . �. ---------------------- ----------------- -------------- Final Inspection by: ------- -- ------ . . -- ------Date----- = ----------- EH --- ----EH 13 24 I SAN JOAQUIN LOCAL HEALTH DISTRICT F85 21677 REV. 7/76 3M