78-597 - Laserfiche WebLink

Home Browse Search

+ FOR OFFICE USE: f 'FOR OFFICE USE: '. "' APPLICATION FOR SANITATION PERMIT Permit No. .- Jam..-7 -- ---------------- ---- (Complete in ,Triplicate) -a Date lssued.-7:��..._Z. F ' This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Heal h District for permit to construct and install theworkherein described. This application is made in compliance with County diftric No. 54�9'ondrexisting Rules and Regulations: 061- .CENSUS ,TRACT--- - � --- - JOB ADDRESS/LOCATI - ti - Y x - ------ _ - Phone__. - - - --.- - - . Owner's Name.-- - Zi k _ Address �.6yP�------ ------ City a 3 '�` 41----- _ .r - -- ---- ---------- -- License #.. - 3 -Phone' _ - � Contractor's Name.- --��- =--- - Installation will:serve: Residence Apartment Huse,Z tial ❑ Trailer Court ❑ .... E 1 ;w... , Motel ❑ Other r= :_ .. s• - SGarbdge Gnndex.... Lot.Size- _._-------------- Number of living units:_=.--...;------Number of bedrooms_.._ e ------ private 1 t Water Supply: Public System and.,name -__..- --.. -------------- _ , - . ! ' Peat❑ Sandy Loam ❑ Clay Loam Character of soil to a depth of 3 feet Sand ❑ Silt❑ (:lay'[]'- .. Hardpan_ ❑ Adobe ❑ Fill Materia L.- ----_---If yes, type------------- k (Plot plan, showing size of lot, location of.sysfem in relation to wells, buildings,-}etc. must be placed on reverse side.) P . pub sewer:is available within 200 feet,) J NEW INSTALLATION [No.se tic tank"or seepage pit permitted if ublic , PACKAGE TREATMENT [']'""SEPTIC TAN K- Size___ --_, -- - D"`-s`---=-Liquid Depth ._-------- - �_No Com artments-.._.. �]r i MatEirial. p - , Capacity-�`�E.).�--.•-'7Ype- ---- - -- -- -- ------- -Foundation:-- - # + p. - _ I . , ` D- ---------Pro fLine_.,�- jam Distance to riearest: Well.._.__1Q --- --- 1 ; ,.. q r LEACHING LINE I Lines r-.,_ Length of-each line,--{_d: v--.: -�--Total Lengthr�..aG?------------- / --------- ND' Bax-I'. � Yp w. ��. � Depth Filter Material l s - .. Type Filter Material . . . ;:::� r • + Q � . .Y ..r .Property Li - -- '� Distance to nearest. Well J_0-4Y ---- -. Foundation —t....: .., ...3.3. b - _... .. _ ock Filled No ❑ Diameter--------------------Num .er-_ SEEPAGE PIT' ' [ Depth-_a: � ;_ Y - - -------- I. t .. x .. .., ;... -----`---'Rock Size —� Water Table Depth =/-Q . = = L ne c� . r -� Foundatwn.. r�-� Prop. I Distance to nearest'Well�;'� - ---;- �. .. Date -------- -- ---- = = - --- REPAIR/ADDITION (Prey. Sanitation Per 't# .-__.- -:--_ _ G - 4"7y - Septic Tank (Specify Requirements).. -- Disposal Field (Specify Requirements): .. fi ------------------------------- - = -------- -------=-------------=----------------------------------------= -------- -- -------- - [Draw existing and required addition`on reverse side) �� I hereby certify that l have-prepared:this application-and that the work will be done -in accordance with San Joaquin Ce ' Ordinances, State Laws, and Rules;,and Regulations of the San Joaquin Local Health District. Home owner or licensed Sig certifies the following: +% that in the erFormbnce of the work for which'this permit is issued, I shall not empaloyiany,,,person in such me "I certify . P ` to becom s ject to. Wo an's ompensation laws of California.','" !: Osar -14 Signed----- _. .._�_-_ vr ,w M a.► � By - ------------------------------------- - Title _ ta. (If other than owner} �- } ri O EP TM.EN USE ONLY x BY- -- - -- - - --- --- - ---- - _ _ ��` ` E# _ ' • . - DAT i� DAT k a - -------- �UMBER. a ----- ..... --_- ...- ... -.- ..- -_ lry .. .... ..- ..- ------------ ------------------------------------------------- ..�.. ,. .. --Date-'----- --- -------- :------------------- --------------------- ----------- -------- - F&S 21677 REV.7/78 2 JOAQUIN LOCAL HEALTH DISTRICT