77-802 - Laserfiche WebLink

Home Browse Search

r- Nona»►�� Ql - �...._.�. -.� FOR OFFICE USE' r](�l�' FOR o F! PPLICATION FOR SANITATION PERMIT F�E�SE: --------- ---------------------------------------------- y {Complete in Triplicate) Permit No.__77=-- 4_- !1 --------------------------- This Permit Expires 1 Year From Date Issued Date Issued4f__-T_;�7 C�y,t �f �. Application is hereby made to the San Joaquin LC Health District for a permit to construct and install the work herein described. This application is made I e with,Coun Ordinance No. 5 and existing Rules and Regulations: Pop" f JOB ADDRESS/LOCATIO. ! � € ------ ------ - "----------.CENSUS TRACT--- ---------- ------------- -------- -' ----------- -- - - Chnmer's Name- '. _ F�_�? Y---71,- Ad-dress � � S - ----- --- - - --- - -------Phone Address - // City Com. i - � - - ---- --------" -----------------zip---------- ---�- ---i- -- Contractor's tit License # .f _---Phone-.----------- e _lG4 L I __ - al Installation"will serve: Residrice� =Apartment House.E] Commercial ❑ Trailer Court ❑ } ; M t ll❑ Other::1 = = = + --- 7 L Number of living units:------ --------Number of bedrooms. �_Garbage Grinder Lot Size �p/_ G . l -------- - WaterSupply: Public System and nam6------- . I--'__- , = .: Private � ! Character of soil to a depth of 3 feet: Sdnd ❑ l -Silt❑/ Clay ❑ Peat ❑ Sandy Loam Clay Loam ❑ } � .. Hardpan [❑ ..Adobe ❑ . Fiil'Material_--_I1,__.If yes;type-------------_.-.____-.._____. (Plot plan, showing size of lot, location'of sys`�tem in relation to wells, buildings, e'tc. must be placed on reverse side.) ` W NEW INSTALLATION: (N6' septi + tank or r seepage'pit pe'Fmitted i public sewer is available within 200 feet] PACKAGE TREATMENT ( ] SEPTIC-�NK "- '�- y i �C'' I ; , Size__; ° Capacityfe.-6-Q----''Type �2n- __Material q - No. Compartments --------------- =----- --` A I k JI Distance to nearest: Weli_..�IQ-t'---------------------- 'Foundation.-- ��____-- '-Prop. Line---- ------- ] LEACHING-CINE ;t "`No:-of Lines_ ....... .........Len `thof,ea h line../D_p; _____.-____Total y`; _ A0 D Box Type FOer_M.t Tial. . ----- ndation.....__ --- ---_--_--Property Line--------- _---_- SEEPAGE PIT [ l Depth----------------Diameter.. ---,----- Number- Rock Filled Yes-E] No : .,,. 4 Water Table,Depth.-- Ai-- ---------==-------1_f?---------i-------Rock Size Distance to nearest: Well.._ ^- Foundation- ------ -- ------------ --- :Prop. Line REPAIR/ADDITION (Prev. Sanitation Permit#_::-_-._'__--_.'.. _.______ -- - -Date_.-- --- .._____ ------------ ----- ] Septic Tank (Specify Requirements)----.-----------�1f,.�[_- - - 1 E =---------------------- ------- ------------------------------------- k Disposal Field (Specify Requirements]_..... _...I ,___-- _---_ ,_ - -- '- ----------------- ; !�, , r -------------------------------------------- _ - --------- ---=---- -- (Draw existing and required addition on reverse side) I hereby certify that'I have prepared this application-and-that-the�ork-will-be-done, irr accordance with San Joaquin County Ordinances, State Laws, and Rules ,and Regulations of the San Joaquin Local Health District. Home ow6'�,or licensed agents signature certifies the following:, 1 r{ ; "I certify that in the erformance of the work for which this to permit is issued, I shall not employ y an y person in isuch manner as to become subbf''ect Workman's C pensa on laws of California." Signed___A311__ .1 ..-P� . ------------ - --- -- ----- s� BY e -------------- --------------------------- ----- -' -- -- - ----------- ------ ---- i (If other-than owner) �y� ^ ` FOR DEPARTMENT USE ONLY I V� APPLICATION ACCEPTED BY__.... -- --- -- - - ---------------=-------------------'--------------------------------DATE.1-30 - DIVISION OF LAND NUMBER:------------- -'.- DATE -----------------------=------------- - ADDITIONAL COMMENTS_............._ ' :, ------------ ------------------------------------------------------------ -- .. _ ........... ............ ........................................................ '.� _ _ Final Inspection by -'.� _ _ ---------------Date ------------------ EH 13 24 JOAQUIN LOCAL HEALTH DISTRICT F&5 21677 REV. 7/76 3M