78-125 - Laserfiche WebLink

Home Browse Search

. - - FOR OFFICE USE: FOR OFF":.E USE: APPLICATION FOR SANITATION PERMIT Permit No._"-7 /,2 -------------- iComplete in Triplicate} - ------------------------------- ""._"._ Date Issued__-3-2�=3=.'7_ �t ----------------- - This Permit Expires 1 Year From Date Issued ---•------------ ----- .made de to the San Joaquin Local Health District for a permit to construct and 'install the work herein described. Application is her This application made in compliance with County Ordinance No. 549 and existing Rules and Regulations: .. _ o- �-- `' - ��:)" --•--- . w _CENSUS TRACT--- , ' -. - ----- ----• JOB ADDRESS/LOCATION -- Phone ------------- -------------------------------- ---- -Owner's Name --------------- --- -- - - ---- --- _ Address ------ Contractor's Name_----- ---- -- - " License P'"---- ��-..__Phone.----------•------• .3 �Apo House.❑ Commercial ❑ Trailer Cour#,Q`' Installation will serve: i Residence p -R: Motel ❑ i Other ------------------ - --- Number of living units:-------- ___._--Number of bedrooms____ ---Garbage Grinder.:__------:-Lot Size_.-.__- private F -- Water Supply: Public System and-name-:,-,-_ _ = _ y= Clay Loam ❑ Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ ' Peat ❑ Sand Loam ❑ Y ' Hardpan ❑ Adobe [Z Fill Material------------If yes, type. _-_ -----•=--- ------------ • erse (Plot plan, showing size of lot, location of system in relation to�wells, buildi'nge'etc.. avabe place le within 2ev feet)ode.) { t NEW INSTALLATION:' ' (No septic tank or seepage pit permitted if public s f *+ f f PACKAGE TREATMENT [ l SEPTIC TANK ( Siz r�-----'�-�!-----' '� - - _ Liquid Depth- K_. __._Material____�Lf°1 .�-------No: Compartments_ ---------------- Capacity-A1141-17 --- ----------- a- , Capacity-"�11�------Type, 2- X Distance to nearest: Well_------ Foundation--;-_ ------------Prop. Line---f ql --- __--Total Total Len No. of Lines.. ____.___-- ,-----.--._.Length of each line.-,_.-�--- ---,- g LEACHING LINE [-,j S P " ox------�_._-TYPe Filter Material-------_"-----=.-- -De th Filter`Material_.__------� `---•------ - + Dist � _� Fou dation ------.Property Line ��`` - D' 13 ---------------- Distance nearest: WeiL`.__--1-. f .- : �-'�'�__'"-T--- --- ".. Rock Filled Yes ❑ No ❑� ( SEEPAGE PIT [ l Depth Diameter-------------- v. •. .... �. . Num Number - �-------_ .. .� - --- -- � --Rock Size------ -- == ------------- s� --- p ` }} j Distance to nearest: Well.------- --- ----- Foundation--------------------------Prop, Line.------------------ Water Table Det ------------------------= • ------------------------------------ - --=-- ------- �--��-=-. --- ---� ,---- -) I REPAIR/ADDITION (Prev. Sanitation Permit#-= ----------=------------------- - ------------ -- ------------------------------------------ - Septic Tank (Specify Requirements)____________ _"-_ • Disposal Field (Specify Requirements)----------------------- -------------------- ,--------- ---- --- ------_---------------------- -------- ---- ------------------------------- --- - -- ----- ---------------- --- ---------------- - _ - - -------------------- (Draw existing and required addition on reverse side} once with San Joaquin County I hereby certify thafil have prepared this application and that the work will be done in accord t. . Ordinances,:-State_Laws,-.and_.Rules._and_-Regulations_of the_San .foaquin,local Health District. Home owner or license agents signature certifies the following: "I certify that-in-the-performance of_the...work_for_which-this permit_is issued,-I_shall..nat employ„any person in_such.manner as to become subject to Workman's Compensation laws of California." �o ' ---- Owner - -- = --------------------------- Signed `c-_. . Y ; (1f other than owner) . ` F R DEPARTMENT USE ONLY . -- ---•---DATE._-”'--��----- -- - - - ----- ----- APPLICATION ACCEPTED 13Y____.- "-- `- ----------=- - - ------------------- - _ DATE._ DIVISION OF LAND NUMBER.. "------------- ----- ----- 7 . ADDITIONAL COMMENTS--------------------------------------- €-- --------------------------------------------- - ------------------ ------------- ------------- ------------------------------ ------------------- --------------------- ----------------------- _ ----------------- : Date-_ .t � Final Inspection b -----------------------------== p y: -' -- ---- -- _ F8.5 21677 REV. 7/76 3M EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT