77-365 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: FOR OFFICE USE; APPLICATION FOR SANITATION PERMIT _ -------------------------------------------------- Permit No. --� (Complete inTriplicate) ------------------ ---- .�Jr. Date Issued._S; _7/ __..._.__ _.__.__.__ This Permit Expires 1 Year,From Date Issued ' eq Application is hereby made to the San Joaquin Local Hea fthCeistrict fora-permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and g xisting Rules and Regulations: _ JOB ADDRESS/LOCATION .. R ��8 CENSUS TRACT_0. ......_-------______ Owner's Nome.:_�h_2?.!L,_-----�/-- . / T,f.. - . --±:.::..al ..: Phone-j- 7 . . - ----- ---------- _ , Address �' +eQ = r. iPy City Z AIN �" _. Contractor's Name ` - - - License ;# '---- Phone '--------- ------- Installation will serve: Residence Apartment House.❑ Commercial ❑ Trpiler Court- ❑ . Motel ❑ Other--- ---------------ta _ t Number of,living units:_ .-________Nurn ber of.bedroom.s_ ....Garbage..GrinderA00 ,-_Lot Size-.----//_-;-1 .1__'___.____ _._.. Water Supply: Public System and`narne ----------- - .-.---_ -; -.: `---'--------------------------- -------- ----- ---------Private ❑ Character of soil to a depth of 3 feet; Sand>[ ;Silt❑ Clay ❑ ; Peat❑ fSandy loam ❑ Clay Loam ❑ Hard ----------------- -------- - pan ❑ Adobe ❑ Fill Materidl ._If yes„stype (Plot plan, showing size of lot, location of system in relation to'wells, building`s, efc:`must be,placed on reverse side.) F NEW INSTALLATION: (No'septic tank`or seepage pit"permitted if p'ublic'sewer is available within 200 feet,]JA ; PACKAGE TREATMENT*'["]- =SEPTIC TANK' ['] i”` `"" ' Size- _ :_a:=": ''__ Liquid Depth l t ' : . TYPCa bcitY- =------ e: - A--Materia ------ i ---�-_No`.-Compartments____--_-'_w_ __- .-_rol_-_.___ __- doflonf. ,_____-.-Prop. Line- ..___ -------- O Distance to nearest: Well. LEACHING LINE I1 Norof Lines �_________________Lengt+of �hi,i` '%rJ `__,Total Lewth.__ .____. _____ ---------- ' 'D' Box_' ___Type Filter Material tF"D ilter.Matertai__ --------------------------------------- D ------- - _ a±�_ e th F - ` T Distance.to nearest: Well----------------- ------ ------Foundation Property Line.. art" :-•�.,.r� �} :+-a�, SEEPAGE PIT {�]. t Depth_.__, _ . --__._Diameter_:___ _-.Number l " a ________. & LL :Rock Fille-1 Yes ❑ No[� ------ ---_- • µ n Water Table;Depth_ __ RSize- - ----- -------------------- ' Distance.to nearest: Well-:-------------------- ___._________Foundation._______ _ _."" Prop, Line._____ 1 �� . „r. , REPAIR/ADDITION (Prev. Sanitation Permit#---------------- ---`_-:------ -- -_----^--Date--:-- --w---------------.---------[ Se otic Tank (S ecif Re uirementsl_- - �. �� -. � .� s Disposal Field(Specify Requirements) �=jj� e-� ' __-7 F ' - M, ___ ____ ------t ----- -- �" i fr ------V-P - J �t d - - ------ ---- -- - -•- -------- ..�-x t ' -------------------------'--------------------`--------------------1 ------- -----------------------------------------f- _ -- --------- ---------- i (Draw existing and required addition on reverse side) 1 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: 1 I "I certify that in the performance of the work for-which this permit is issued, .1"shall not employ any person in such manner as to become subject t Workpian's lCompenscition I ws-of California." BY -= = - ' n`er[ Title -Ti tle.- --------------------------- --------------------- (if ----- (If otherthaow ` t F QEPA ♦ENT USE ONLY t i . .l t . ¢!t' R ,.__DATE._ + ' APPLICATION ACCEPTED BY--------- - -=-•-=-" ---�� - --------------------------- �- ----------- --�--- DIVISION OF LAND NUMBER--------------------------------------- --------------- :. - DATE ----------------- FADDITIONAL COMMENTS--------------------------------------=------------------------------- ------=-- :-------------- - ------------ ---------------------------------- -----------------------------.--- ------------- ._-.________._____--_-___._-___-,.-_----------------------_--------------------------------_------------------------------------ ------ __-------_______---- --______ _._ _ ------------ -------- ---------------- -- -------------- - ------ ----------- -------- ------- Final Inspection by:_:. '= -------='--- ---- ;-__- Date-5' �G eH 13 24 SAN J0AQUIN LOCAL HEALTH DISTRICT Fps 21677 Rev. 7176 snn