78-635 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ' ' A Permit No. _X-7 `3' � ----------------------- -- ------- ----..........----- (Complete in Triplicate) .------... Date Issued. - 1_. This Permit Expires I Year From Date Issued .......................... .. 1 Application is hereby made to.the San Joaquin Local Health District for a-permit to construc't.anrk herein described. d_install the wo with County Ordinance No. 549 and existin This application is made in compliance. Rules and Regulations: �r} a CENSUS TRACT..-,-------- .. ...... i JOB ADDRESS/LOCATION- ®.. } / '� ..-•---" - ---•-- one....-.. - --- .---�--"-�- �-•-" Owner's Name ...1.:. .. ---- -- i 1 Y .... -- .. -- Zip--------- ----. ..L..� - ------- !� Address...-- - - - -- " - - --� 5 07.! Phone.. Contractor's Name-- --- -"_ _ _ ............. ......... .. .. ..License #...-- Q -- - �" :.... r ' Commercial ❑ Trailer Court ❑ Installation will serve: Residence Apartment House ❑ wMotel ❑ Other........................ -------- ------ ------ - "-- Number of living units:......I.-,..---.Number of bedrooms----�J..Garbage Grinder..------ ---Lot Size.----_ - Private Water Supply: Public System and name.- ..... Peat ❑ Sandy Loarn ElClay Loam A ElCharacter of soil to a depth of 3 feet: i Sand ❑ Silt ❑ Clay ; Hardpan ❑ 1 Adobe ❑ Fill Material.. ._ ....If yes, type--- `•---..---- '1 (Plot plan, showing size of lot, location 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 240 feet,] %11 �- __ Liquid Depth..... Size .- --- �� -- " PACKAGE TREATMENT ( ] SEPTIC TANK' ( ] * X -�— t "�-- --- --- -.No. Com artments--.-- --• ---------------------- Capacity-JA - --- ------ -- --- I Capacity-- . Type Material..--- --- - . p .. �7 'i Foundation:_ .L/i _. -.. -. .-.Prop. Line...------ - Distance to nearest;.Well...-.f .��--- "� •-- � yy,, ..,Total Length .. `- {,f LEACHING LINE I ] No, of Lines Length of each line .-.- d`---- - P 'D` Bax..-..!_..:.Type Filter Material. Depth Filter Mater+al.-:. ----:.. ----....---- --------- Property Line---------- ----- /®� Number p y Distance to nearest: Well----- Fou - Rock Filled Yes�[ No ❑ SEEPAGE PIT E ] P ..Diameter / , Depth. _ . i Water Table Depth_------------- ..-...- -- ._..Rock Size-_-�.... iProp. Line--------.-" --.. ..... . Distance to nearest: Well------------------------ ..........-........Foundation ----- ( Date..."----------- ----- ------ .............. ] REPAIR/ADDITION (Prev. Sanitation Permit#---- ------ 'j Septic Tank (Specify Requirements)- --� - -------- ---- --------- ------ ------ --------------- ------"" -..----- --- -------- ----- Disposal Field (Specify Requirements)"............ ....... •--- . .-.- t ----- --------------------------- ----------------------------- Dr-ow existing and required addition on reverse side] I I he 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 signature certifies the following: manner as "1 certify that in the performance of the work for which this permit is issued, I shall not employ any parson in such to become subject to Workman's Compensation laws of California." .... ._. . -- .. .-- --�-�" ----- - ��------ " - "- - " ---Owner. Signed - �-- �� "--- - .. Title "- --..----""---------- ----- -- --- - ----------- -- --- By if other than owne ENT USE ONLY - DATE ... 7 !./ ..-..._... --_. FO DEPA I APPLICATION ACCEPTED By------- - Z-"---._-"-..--..---.- DIVISION OF LAND NUMBER..-. ...... "..-..-. - -4$f ADDITIONAL COMMENTS-...---" YVLt, S --- p -,_� 7".?� -------"- - � s _ ' 40 ------------------------- - - - -----... .... .... . ... ...�---- ----- ----- ---- --- Final Inspection b ......Date.---" ..--• ---- - Z �.._.-...- ." -� - - F&5 21677 REV. 7l7b 3! SAN JOA4UIN LOCAL HEALTH DISTRICT r EH 13 24