78-520 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: g. FOR OFFICE USE: APPLICATIGN FOIA! SANITATION PERMIT Permit No.__7.f-._ _-_ - J1a ...-- (Complete in Triplicate) E ------------------ ---------------------------- is Date Issued._..__._.__ . ,� t .. J ________________________ ______�______-,__:_-_.____..._ This Permit Expires 1 Year From Date Issued "`4". Application is hereby made to the San Joaquin Local Health District for a permit to construct and install ytile work herein d-e--scribed. This;;application'Ss"madi='in compliance with Coun'ty`O'rdinance Ido:549 an`d existing"�ules and Regulations_ R ll JOB AQDRESS/LOCAION ' � ~ ' 1t,=--- - `l= = L!"1 CENSUS TRACT' Owner's Name _�.x `sQ ' rte' ne <' _ F l 1 Addc �j ress------ .r .. l-a-- .-. --. City -' ----------ZiP E i --- ' -- -- -/- -- -- - -- Contractor's Name_. ___. ____ _�_.Q.._ - '�.. `s License # _ __? �Z-7-_.__Phone_- 1_ -73z__-_ [ Installation will serve: tj F Resid4nce;❑4 Apartnienf';Hou , 0 Commerc al ❑ Trailer Court ❑ 4 k E. Motel ❑ Other__ ' [ Number of living units:_?-. 1 �..y -�L [ ' g ______Number of drooms-__ __ t Size Js c 1 � l s � r �_�_Garba Garbage # Water Supply: Public Syst and.fiame.___ llic.[. � ___.�___A__ t _____-_-- „_,_=____Private '. Character of soil to a depth a 3 feet: ' Sand ❑""`Silt"❑-flay ❑� Peat❑ Sandy Loam'Ej Clay Loam ❑ ° { tHzirblpanl❑ AdobeX Fill Material--..------.._If yes, type... L �..,--- (Plot plan, showing sizei.c, ot, location of system in relation to wells, buildings,!etc. must be placed on reverse side.) i k 1 4 NEW INSTALLATIOW o septic tank or seepage pit permitted it public sewer is avatlahle within 200,feet,) PACKAGE TREATMENT -j a 'S£PT1C TANK ssi --------------- --------------------.1iquid De th.-----------------#-_-- Capacity --T TYPe `` `� =Material------ --- ---No. Compartments----------' ------------=----`e Distanee-to nearest: Well_______________�_�_,_ ------ - Foundation -_ -________.Prop: Line- 9 ----------------- LEACHING LINE No, ofi _T e Filter MatereaLth o ea lige Depth Filter Material Total Length -_ D' Box--- Yp P --� --------------------- --------------- : A 1 Distance to nearest: Wel ___._Foundation / ._ ----------- _ -___:Property-Line----- ---------------1----- SEEPAGE PIT Dept� ___Diameter� _.__.____Number _r t-------------- Rock-Filled Yes " No C, Table-Depth � d �': ' Water Table Qepth. ock Size.--- - - - ''� Distance to clearest; Well..:_��_�______________________Founddtion �Q ---- -___.Prop„Line-_._ �.____._.-___- ____- REPAIR/ADDITION (Prev. Sanitation SPermit#- --------------------------------------------------Date4`�`--_�._ '"�Y6'� -” ----- c Tank (Specify Requirements) t._ -- --- --- -- - -------------- SeptDis 'osRe ------ Pal-Field-(Specifyrw � k . _-Require - - "`t'� , -----------•--------- ---------- 1 ----------------- ---- -----------------------------------_ . ---- --------- --- ---------- -----------------------------'' -------------------- ------- , g ' t {Draw existin and req"uired additiorron reverse side) I hereby certify that I have prepared this'application and thatl'the work wili be done in accordance with San Joaquin County Ordinances, State Laws, and :Rules and Regulations of thea San Joaquin Local Health_ District, Home owner or licensed agents signature certifies the following i I "f certify thatin the performance of the':work.,f%which this permit is issued, I shall not employ any person in such manner as to become subject .to_Workman's Compensation'Jaws of California.'" �' ¢ # ELARENCE'S SEPT,C & SEVvER SERVICE Signed.- = 3 -----------------Owner 2G3 o. Oro . Sio�fctort, Calif. 9520 . i B -- - - i - 1 ------ - - _ -_ - - --..-.Title ._ - # Y - -- - b._453..;2�9 f �--"* �'(I of re'than owners -� f F R D PARTMENT USE O�LY APPLICATION ACCEPTED BY --- - ---- ------------------------------------ --------- -------- DATE ----------4.;.78.'---7�----------- DIVISION OF'LAND-NUMBER. - -- --- i---DATE._.. ---------- ----------------------- ----------- ADDITIONAL COMMENTS ------_. - --- tr ----------------------------------------------- ----- 1 l , ----------•_--------------- ---------- ---- ---- -------------- -------------------------------------- ------------- ------------ ----- ---------------------------- ----- - I i I -------:-- ----------------- ---- ------------- ---- ------ --------------------- -- -- -- ------- -- ---------- ------ --- - -- - ----- - ------------------------------- - T ------- �'"_- ---- --- - -----------------=---------- ff 7 - ---- Final Inspection by: - __� '�''"'' ' *� - - __Date C� -�`- __� _ EH 13 24 � x SAN J� AQUIN LOCAL HEALTH DISTRICT r said REV. 7176 3M