77-248 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit Nd. _ (Complete in Triplicate) 7 7.. y.. ..........•..._._...... r .. ._ ....................................................... This Permit Expires 1 Year From Date Issued 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/LOCATI N .._._ ... , ,rt �.......................... . ....................CENSUS TRACT :....................:._._ t Owner's Name ------ ....................... ..................... ...:................Phone .....................---... ........ Address -. 1 .-- ----- ---------- --- Cid.. � ..Era,' .� ................... Contractor's Name ell ' - ---- J �_��i��.�f�...�.�<�....._..License # .��./..� . Phone Installation will serve: ResidenceP�(,Apartment House f] Commercial QTraller Court ❑ Motel ❑Other...........':•:............................. Number of .living units:_::-_/'__Nurnber of beds ours `.._..Garbage 'Grlhder '. :::.... Ldt'Size ..... .x.,f.. .. r. Water Supply: Public System and dame O61.1-16Lr pp Y= --•------- -- ------- -•-- --r-=�'�'-�.._.......------...---•--........._._._................Private Q Pi Character of soil to a de th of 3 feet: Sand Silt Ga_ Peat Sand Loam Cla Loam p ❑ ❑ Y ❑ ❑ Y C] Y C] I Hardpan Q Adobe,V fill Material ............ If yes,type ............... ............ v k (Plot plan, showing- size of lot, location of system in relatia to well-s,`buildings, etc. must be placed on reverse sldei%\�y NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,[ PACKAGE TREATMENT [ } SEPTIC TANK I ] Size...................... ..� • =...................... Liquid p Depth .......................... --- , Ca Type -•------------------ Material -------------•••- No. Compartments ------------.......... Distance. to nearest: Well .. .................................Foundation ---------------------- Prop. Line ...................... G LINE [ ] No.-of Lines ---.../-------------- Length of goo line.._....f�_•-X/..C�/_ Total Length ----/.6........_.__.. i LEACHING � - f j .,. E Yip r.y - p Filter Material .... 0...fP ?x-'_ D' Box T Filter Mat tial I.L15,. _ ..De Depth ----------- Distance to nearest: Well _ �►z- . Foundation fQ: ............. Property Line . .............. x 1: .._' IIx y SEEPAGE= PIT I b. ._..-•__-. Rock Filled Yes Q No iQ [ ) a Depth ----------- Diameter .,...........:- Number ....... -<.... .. ` ROek Size` Water-Table'pepth . ............•........---------•-.._.. . i Distance to nearest: Well .Foundation Prop. tine .... (Prey. Sanitation Permit# ----•--•.-•------.-----_ _...---___..--_- Date .--:.t-------------•----:�---•-[ 'Jif Septic Tank (Specify Requirements). f_' r ----------------------- Disp sal Field (§ eciY q f Requirements) ��. _�G .°=: __ .�(._�/o X./.._ --••-•................................. - - -A(=.,.... _ �.�C`�'...1 C�._.__.. ,,kC�.C.ii.'Y�_._..... ------------ ----- [ _ [ k. (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application-and-that.the-work.will be clone in accordance with San Joaquin County Ordinances, State laws, cine! Rules and Regulations of the San Joaquin Local Health,,District. Hance owner or licen- sed agents signature certifies the following: , 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 beta ub[ect to Woc(Sm n's pensation laws`of Califernla.''_ Signed 'c'e --- - _- -- -C�G, Q. -- - ------------ Owner BY ----- ------- ----------------- _ . - ................................_....------------------------- ._..__. (if other an ner} FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED�BY _ ". :.__. DATA .., .c�5�..7 ._..._BUILDING PEi2MIT ISSl1ED . -------_----------------__DATE ---- .------------------------------- ADDITIONAL COMMENTS ._ _.....-_..••---.._..----- ------------------ 4 ---------•--•------------------_.--- --------------- ._..>._._".,---------------------- •--------------------------------- ............... .------- ------------------ - ------------------------------------------ ---._.. - - Final Inspection by: - = ..............Oate . ._. ... -.0--..,1_ . EH 13 2!t 1-68 Rev. 15 5r SAN JOAQUIN L AL HEALTH DISTRICT 8/7$ 3M E S