79-596 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: FOR OFFICE USE: ' APPLICATION FOR SANITATION PERMIT ------------------------------------ --- --------- (Complete in Triplicate) Permit No. --------------- ------------------- - -- - 1 u71j Date Issued__!-"_.--------- -------------------------------------------------__- __ This Permit Expires 1 Year From Dake Issued I 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 Or ' once No. 549 and existing Rules and Regulations: -' ` JOB ADDRESS/ OCA N_-- - - _ .- ' _. Q- 1G�/ - .-.--.-_ �_-____- __-.CENSUS TRACT.________..-_. Owner's Nome------ _ ------------Phone_ - "------. , City �"�°' - -----------zi --- Address--- r �6._. --o-�a ---�------ - P S d - Contractor's Name----S,�_�r---------- � / 3�Oc�''3� ------------------ -- -- --------License # _44_S -------Phone---- ----------------------------- Installation will serve: Residence Z�-�Apartment House.❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ---------- -- '- ---- ------ /. Number of living units:___- -..--__-_Number of bedrooms- �----Garbag�Grinder -Lot Size---lJ-- --_- .------------------- ---- Water Supply: Public System and name _ -. _ ---------------- ----- --------- ------ Private Character of soil to a depth of 3 feet: Sand ❑ :Silt❑ Clay ❑ Pegt1(] Sandy Loam [� Clay Loam ❑ - Hardpan ❑ ; Adobe ❑j - Fill Material------------If j s, type --------------------__--..- (Plot plan, showing size of lot, location of system in relati tno o wells, buildings;"etc. must be placed on reverse side.) NEW 'INSTALLATION: (Nor eptic tank or s� age�p'it�perrriitt�d i public sew is available within 200 feet,l k PACKAGE TREATMENT SEPTI � Size_ 9 i , Liquid Depth. 6- ---- -- --- CaPacty-- --Type-- 4M #�iaL=:CCA-. -=No: Compartments____2----------------____#___ r Distance to nearest; Well tU------------------------ _Foundation-----16-----.-------__.,Prop. Line--------------------------- LEACHING -_---d-__--------------LEACHING LINE [y-- No. of Lines_i____2--- .---;._-___. Length of each line.---Y'S g U } ----------------Total Len th.--,.•,- 7 ' 'D' Box-- - ?--T II s 1 ?_.Type 1 filter Material:f / Depth Filter Material .. .. � � Distance to nearesta : Well-:--1 ._____-___.Foundation-.-J.�--- --Property Lirie____�.Y_�_____-_____ . SEEPAGE PIT De th_�' _ Diameter - Number—_----Z—_-___________ Rock'Filled Yes� No If �,. Distance to nearest: WeII �= _ Rock Size ` � J Water a e De th_____-_____ -- if �a . ,.. Y` i � U =-- --= ---- ------------'--.Foundation : 1 S- -----.�-.Prop.;:Line---�� ---- ------- -4 r - REPAI /ADDITION (Prev. Sanitation Permit,#__---- -- - "� __---__--__ - aDate- Septic Tank (Specify Requirements) ---------- -----=-- -------------------------- = -�'-`- - a s v DisposalField (Specify Requirements)---------------- ------- ----=- ----------------------------------------------------------- ----------------------------------------------------------- a (Draw existing and required addition on reverse side) I hereby certify that-] 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 becomWsubject rkman's mpensation laws of California." Signed ---:Owner ---By-------- -- ---- -------- --------------------------- -------Title---dt�xe- ---------�------- - other than owner a FOR-DEP.ARTME1 T USE ONLY APPLICATION ACCEPTED BY---" �- --- --- --- ----- - ------------------ - _DATE.:- -' .-� -- ---------�'- --------- DIVISION OF LAND NUMBER-------------------------- -:------___--- ------- ------------------------' .: ------------------- DATE---------------- --- ---- --- ----- --- ------- ADDITIONAL COMMENTS --- - ----------------------------- ----------------------------------- ---=------------------------- ------------------------ --- ----------------------- - --------------------------------------------- ------------------------------------------ - ------------- Final Inspection by------------ ----- x Date___ EF! 13 24F&S 21677 REV. 7/76 3M SAN JO QUIN LOCAL HEALTH DISTRICT