77-660 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USF: APPLICATION FOR SANITATION PERMIT FOR OFFICE USE: 8. -- Permit Nod' (Complete in Triplicate) f0 �^----- • F '-k i! � k° .� `��,.�,� � � Date I ssued_.�_ls.i,;,� . ---------------2---------------- -------- ----------- + This Permit Expires 1 Year,From.DateVssued 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 I N.., _ t , _ CENSUS TRACT -- - --- { - Owner's Name ti ' ._,._ .. ._ r r`' ' =7 Phone-_: - - -------------------------------- Address--- ---Qr3= Lf= r City. Zi -' Contractor's Name- ----- _`— ----:---- -L -------------=----- License #_ - Phone G s� �G Installation will serve: iResidence Apartment House.❑ Commercial ❑ Trailer Court ❑ Number o .. -w- .. . . Motel--f. Gther-�-=:------ ----------------------- r } f living.units:.._. '------Number of bedrooms_ =_.__G rbage Grindea'_ ........ Water Supply: Public System and name-.-------- ''`h - .-Private e j_: vat t ...,..F.. f, Character of soil to a depth of-3 feet: : Sand Q Si it '.!,Clay ❑ Peat 0 Sandy Loam L] Clay Loam-❑ Hardpan -t-.Adobe Fill Material._.__'__.__If yes, type------- _.-_-_.--_ ---------- (Plot plan, showing size of lot, location of system in relation to.wells, buildings, etc..must be placed on reverse side.) • !ti NEW 'INSTALL'ATION: I(No septic tank .or seepage ;pit permitted if public sewer is available within 200 feet,] PACKAGE TREATMENT ]']' SEPTIC TANK 'I'�/7Q'}/ Size_____gy-5 rf_---------:-.___________________Liquid Depth._-.I_____/_______ • K ! 1 .�,: 5 1. W� a. acity-�.a�__---_Typt - -- --- -...__Material. .__ ---..__ _No. Compartments--------------------- $-------- Cap Distance[ao nearest: Well.;,_.--__ {. __ -__ Foundation.____ .-Prop. Line._•. } ------ . LEACHING LINE [t. No. of Lines-____-- _-- � i;e.-- ---------.TotaL�Length::----- -7- ----------------------- -_ :Lengthrof_e/each_l'n re Q Box �_�__:._Type Filter Material:��lk____ Depth Filter Material__ -_-._ � ._________________c._ ------ 999 w -. , Distance to nearest: Well Foundation----1..____.____1___.Property Line... 1�1 A SEEPAGE PIT ["�J Depth__ ._:___.Diameter_._��. ________Number___:-_--- -._'_____._____.___ Rock_Filled Yes No ❑ Water Table Depth-------/0---`----------- ---------------------.---.Rock Size- 71K --------------------------- � Dista rice�to nearest: We11.--__ ------------ - Foundation- �'" -- -L ____._.Prop. ine----------------.-------- _-_ $ ` ¢ REPAIR/ADDITION (Prev.. Sanitation Permit#_______________-_-_______..___..___.-----;-__---.Date__--___-__"____..__�_________..__-._---------.), Septic Tank (Specify Requirements)--?--- --------- - j Disposal Field (Specify Requirements): '------------------- --------------------- --------------- ------------ --- --------------------------- ----- -- --- ----------------------- ------------------ ------------------- ---------------------------------------------------------------------------------------=--------------------= --------------- ] (Draw existing and required addition on reverse side) { I 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 signature certifies the following: . "I certify that in the performance of'the'work'for which this permit is issued, f shall hot 4mploy any person in such manner as + to become Ubblect,to Wo mans Compensation .laws of California."Signed - --, � f..__. -- ------- J, . Wne I `O r . >. 7. s . .. - _ / Title. - - _ it By = - -- -- _ (If other than owner) `° w t [ FOR-DEPARTMENT USE ONLY h APPLICATION ACCEPTED-BY-:----------------- - - y �- � �- �� ------DATE.... - -- S-77-- ---- I DIVISION OF LAND NUMBER..: ::_. - .------- ------- . --- ------.DATE--------- _ {; ADDITIONAL COMMENTS--_- ---------------- ---------- ------------- -------------------------------- --- --:----- ------------------------------- --- ---------= --------- ----------------------- --=----------------------------------------------.------- ---- - --------- --------- ---------------------- ------ ----- --- --- ----- --------------------;- ---.:-----------------------------a---------------------------------.......................... ------------------------------------------ ------------------------------------------ ------------------- ---------------------------------- - . + Final inspection by J - cste - g Y -7 11 EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&s 21677 REV, 776 inn