79-130 - Laserfiche WebLink

Home Browse Search

'`FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ------------------------------------- -- ------ ------ (Complete in Triplicate) Permit -------------------------------------I ---- ------ --- Date Issued-9_ -. - 7� --------------------------------------------------- __ This Permit Expires 1 Year From 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: i f JOB ADDRESS/LOCATION. ��; =__.CENSUS r>�ACT • - IT __- p._..---__-- Owner's Namei--- ^-'--'----�' _0_!% :_- :Y— :_��__ • ------ ----------------------Phone_=- Address U. �%�� '4 ---- City- i fi`A'-C Cd - Zip ` -- 3 L� [[ r� p� Contractor's Name - -1 �' =�AV �•`' �� ---.---Phone- ( _ M I rV 4 - --------------License #_- 1 ,�5. 1 Installation will serve: Residence Apartment House E] Ca)mercial ❑ Trailer Court ❑ - - -- - " Number.of li.virig units:_ �_ --____Number;of l3edro.om�_ Garbage Grinder-_ . -;_Lot Size_ __ ___________________ ____ -.__ ___ * . . Water Supply: Public System and name_ _� -•:�-----� - ----.�'�--i----=-------------`-------------=-- ------------------�-- -------------------- Character of soil to a depth�of�3 feet: SandFOLSilt❑ lay ❑ Peat ❑ Sandy Loam iClay Loam' 1 ardpan ❑ : Adobe ❑ FiI-I-Material___ =y. _-Ef yes, type----------------- H _ e= ,r1 ,.(Plot plan, showing size of lot, location of system in relation to'wells, buildings, etc.!must be:placed on reverse side.) NEW INSTALLATION:— (No septic-tank'or seepa `pit permitted if public sewer is available within 200 feet] PACKAGE TREATMENT" [ } SEPTIC TANK t Size------ -0�-_ 4A" ---`-------s-___Liquid Depth#.f---------------------o s t Capacity-Vao-0� Type - ---------------1__Material-- C�-�'4-seme�'��lo:•Compartments---- _-- -- '-----------------4 Distance to nearest-Well.--C-6 --------------------------------Foundotion----- -Q-----------_----.Prop. Line__, =_--_--------- LEACHING>LINE. [ ] No. of Lines-------, --------- --- -Leng_th ofIeach line- ___- d-,_- -_-- __.Total Lengthd- �__- - i, p ,. _- Dox---- yFilterMienaf .✓ ` ter Material_. ___._ 9 ------------------------------------------- B Distance to nearest:'Well__ � �_4_ -- Foundation__ =�D� `__ i .Property Line......5.6 ----------- SEEPAGE-OT [ -»•-.---Depth---- -^-DCarrmeter.: _--_.4 __ti tuber_______________ _______ i Rock Filled Yes E3 No --De � � 4 t > i Water fable Depth' - -- --- --- Rock Size #' Distdnce-to nearest:Well--'----- -------=-------------'s______=_----_Foundation-------------------__-_--.Prop. Line__ r ' ------Date----- _ _ 1 REPAIR/ADDITION Prev. Sanitation•Permit#_-•___-__�-�-'_____ __________ Se tic Tank S ecif Re uirements ` _____ '__:_-____ _ -__ _•__________ _ _____________________ Disposal Field (Specify Requirements)-------------------- - ----------- -------------------•----------------------------------------=-- -----. -----=------------------- ----------- ----- - ------ ---------------------------------------------------------------=-- -- -------------------------------=----- -------------------------------------------------------- -------------------- --------------------------- " f (Draw existing and required addition on reverse side) 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: i -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 beco a ub' ct o Workm s Com ensation. law f C lifornia. p BY4---------------------------------------------------=------------ --^------------- ---------------------Title------------ --------------- -------------------------_------ (If other then owner) r; OR DEP TMENT SE ONLY I APPLICATION ACCEPTED BY- - ...... - - ------ ---------------------------DATE -------------------- ---DATE DIVISION OF LAND NUMBER ---- -------- --- ------------------ DATE : ADDITIONALCOMMENTS--------------------------------------------------------------------------- --- ---------------------------------- ------------------- --------- --------------- -----------------------------------------------'-------------------------------- -------------------------------------------------- ---------------------- --------------------- ------------------------- ` ---------- --------------------------------------------- --------------------------------------- -------------- ��Final>Insection - Date - = - -_ — ._ - ------ - EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT rs/s'21�677 REV. 7176 3M