77-955 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: FOR OFFICE USE' a:; APPLICATION FOR SANITATION PERMIT [Complete in Triplicate] Permit ---------------------- _' - l Date lssued..Y-_1s. _7_7 ------------------------------------------------------ __ This Permit Expires 1 Year From Date Issued 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/LOCApT�IONN------- © --- --_- `r- Q14-a--- - ---------------------------------CENSUS TRACT.------------------------------- Owner's Name------- Phone__y4. .22/9 ------------ Address.--p34_---__;�F------�� -- -- - ---- -- -- - ---- ----- ----- ---- ----- --- --city ------------Zip--?4�_-0 17------- Contractor's Name._ _"'___- -A► ----- _ -_-----------------------------------License #---R.7 _5__3__?_.Phone-___y Installation will serve: Residence W Apartment House.❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other---------------------------------------------- Number of living units_____ ___________Number of bedrooms... �----qGarbage Grinder------------Lot Size--------Q.__x _ ___________---------______ Water Supply: Public System and name___.____--------ESV_ ---------_____ Private ----------------------------------------------------------------- Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat ❑ Sandy loam ❑ Clay Loam ❑ Hardpan ❑ Adobe [ r 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.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK Size __'c� sx _______ ___________________________Liquid Depth._---_----- Capacity_.�_v-q.0_.-----Type-PM-1T ._Material_ed_ C-t----------No. Compartments-------------17------ -.----~-- r Distance to nearest: Well...... ------------------Foundation------1Q___-------- Prop. Line------ ---------- LEACHING LINE [ Na, of Lines-------00r...._------ ----- Length of each line-----7-d _______________Total Length.__._____e- �.r _ 'D' Box------------Type Filter Material_�S/, k.Depth Filter Material___1k_ ------------------------- ---------- Distance to nearest. Well-----//t G^A_*`-------Foundation----- Q________________-Property Line__4-------------------------- SEEPAGE PIT [yam Depth_;L;sl---Diameter... .____------Number------ ----------------- ,t *r Rock Filled Yes, J No ❑ Water Table Depth I-—-�-------------------------------- Rock Size ----- 3 ------------------------- Distance to nearest: Well____-__-- -------------Foundation------ _._____.__.Prop. Line_________ REPAIR/ADDITION {Prev. Sanitation Permit#__________________________________________________Date_____ Septic Tank (Specify Requirements)__._ i-7------11411501d Disposal Field (Specify Requirements)___- ______ ___ -_____ -------------------------------------------------------------------- ------------------� a ------------------------------------ --- ` --- ----------------- - ---------- ---------- ----------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ (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 signature certifies the following: "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner as to beco a su ject to War COS Co ensation laws of California." Signed ------------ Owner 1 --- ------- BY --- - ----- ------- ----=Title---- --------------------------------------------------- - (If other than owneff DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- - ----- ---- ---------------------------------------------------------- -------------------DATE.- ,�4 ----------- DIVISION OF LAND NUMBER------ - ------- -- --- ------------------------------ ------- -----------------------------------------DATE. --------------------------------------------- ADDITI AL COMMENTS.----- --- ----......- ---- ---- ----------------------------------------------------------- --------------------------- - --------------------' -- ---- --------------------- --------------------------------------- - --- - - --------- ------------------------------------------------------------------------------------------ -------- Final Inspection by.- --- f ---------------------- = : Date--��-/ � EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT 1• 21�Ev. 7/76 3M