77-853 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ------------------- ----------- --------------- - i Permit No.._7.7� S� (Complete in Triplicate) -----------------------------------I-------- ---------- Date lssued.f�-n2_.f_-,77 ,---------------.--------------------------._- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Lob 1 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/LOCATION_.--.--!_-,_0_e _� ly'��t-`�`�-R TRACT - ---------CENSUS Owner's Name"------- --------------=--- ------- -------------- ---------------_--------Phone- ------------------ --- ------------ Address--------------- ?IRC_U City �' 1�` -t' ---Zip-------------- --------------- �. T.. Z G Phone-------------------- - -- Contractors Name------- = -- _' . -r- ---- -License #_ a �..- _ --. Installation will serve: Residence [ Apartment House.❑ Commercial ❑ Trailer Court ❑ ' r - Motel: ❑ Other - . _.." Number of Living units:- ------ :.__Garbage Grinder__.=----__--Lot,Size-------------------- --- ------- ----------- Publics stem 'and name-___--___r_ _____________ Number of bedrooms_.__ WaterSupply. y -------- -- -=---------- -`---------. ----------------__ ---------- ---- ------------- Private Character of soil to a depth of 3 feet: Sand E] .Silt ElClay ElPeat ❑ Sandy Loam ❑ Clay Loam Hardpan ❑ Adobe ❑ Fill Material:. --If yes,type-------------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must.be piaced on re_veTse side.) i NEW INSTALLATION: (N o septic tank or -see age pit permitted if ublic sewer is ava lay ble withm 200 feet,) i J: PACKAGI=TREATMENT [ ]' SEPTIC TANK . [►'� ' Size �- -�-- ---- -Liquid Depth.___1/ --------- Ca FT M � { ,i _ S . atonal - No-Com artments- ------------------------�( ..'Distance'to nearest: Welli_—,_,� -- --- -=-•1-Foundation:?__ '/ _----- -Prop.;Line___.-j -____'_ LEACHING L1NE. " I �] No. of Lines.:.__:- :__-_.,, -__-- Length,•of each line._.1''__ -------=--------Total Length. _____ --------0 # D' Box = TYPe Filter Material------��-�------Depth F..ilter-Material-- 1r� =::_ .40 Distance-to nearest: Well-; ------4�� F.ounclation------ �jr -_, roperty Line_"___ "Zw---��------- P Rock Filled Yes No❑ SEEPAGE PIT [ De th � Diameter -_ .3_ `._- Number --- t Water Table Depth"- - -------Rock Size---,/Y -- 'r --_- ----- -- -- 'Well_______" -------,---- Foundation__ _.__ ;'_ Line-----� -----___-_Distante to nearest: e . a j-. k: REPAIR/ADDITION (Prev:Sanitation Permit#--:----=--- --- -------------------- --------------.Date------------_----_- -=----------------- } [ - ---------------- --------------------- ------------Septic Tank (Specify.Requirements[ : ., Disposal Field (Specify Requirements)--------------------- ---------------------------=-------------°--------------------------=-------------:--------s-- --------- -----."---------- ---------------------- - f -• ------------------- ------- :. --- -------- ----- ------------------------------------------ ------- --------- --------- -------- ------ ------- : (Drawexist'ing 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 R Ordinances, State Laws, and Rules and Regulations of,fihe San Joaquin Local Health District. Home owner or licensed agents signature certifies the following: 0 ' "I certifythat in the erformarice'of,the"work for which this permit is issued, `I shall not employ any person in such manner as P to become..sub[ect to,Workman's Compensation .laws .of California." k -Owner •. Signed---------- ------------- - ------ t BY ------ I = Title -- Ifother than owner] r ; 'FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_ -/ - __DATE - ------ -- 777 - DIVISION OF LAND NUMBER:----.---.--------- ----- ---------- DATE. ADDITIONALCOMMENTS.-- � ------------------- -----=--------------------------- _---------------- ---------------------- ------------ _ ----------- ---------------------- . . - .... _ -------------------------------------------- ------ ------ --- - ---------------------- - --- ----- ---- { - -- -- --------- ------------- ------------- � f Final Ins ection by:-----'-- . - = ---------------------------------- -------Date.-:.__ �J � J� P - EH 13 2a SAN JOAQU LOCAL HEALTH DISTRICT r&S 21677 REV-"7/75 3M