77-583 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: FOR OFFICE USE: I APPLICATION FOR SANITATION PERMIT Permit ---------------------- -------------------------- .3 - No.__77--5� (Complete in Triplicate} - _i Date lssuecl_ -- - ••----------------------- ______.__.__ This Permit Expires Year From Date Issued - Application is hereby made to the San Joaquin Lacal'lJZth District,fora 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: JOB ADDRESS/LOCATION ---------- --------------- `------- CENSUS TRACT --------------" ............... © �/ a Owners Name.------------- "' - `" ---� - ' ; PhoneZ9 - Address---- ------------ --- itYi zip - Contractor's Name---- -----l------* _ -, License #��3-°�� Phone Installation will serve: ' Residence Apartment House E] Co mercial ❑) =Trailer Court- ❑ Motel ❑ Other----------=----- = 1{ - mber of living units:_= -----:.___Number of bedrooms._____ arbage--Grind ---Lot Size__--" _--- ------------------- Nu -- i Water Supply: Public System and name-------------------------------- --------------A- ------- _- -- ----- Character --- =_ Private ❑ Character of soil to a depth of 3 feet: Sand-E] Silt ❑ Clay ❑ Peat 0Sandy Loam' Clay Loam ❑ . E 1. Hardpan ❑ Adobe E] 'Fifl Material---"-""-_ -'If''yes,,type---_---------------------------- _ (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 seepage-pit-permitted-if-pTjbiic sewer is available within 200 feet,) f f PACKAGE TREATMENT [ ] SEPTIC TANK [ 1 Size----- -------------------------------------------------------Liquid Depth----------- --------- Capacity------------------ --Type------------'----------Matarial--'------------ ---------No. Compartments------------------------------- Distance to nearest: Well---------------------- --------------------Foundation.-------- ------=-----Prop:.-Line------------------ ------------ LEACHING ----------- --- 6 LEACHING LINE [ ] No. of Lines------------------------------ Length of each line.------.----r--------:--- ----.Total Length --------------------- --- 'D' Box------------Type Filter Material--------------------Depth Filter Material.- -------.---•----- ]------- =- ------ s n� Distance to nearest: Well-------- -------------------Foundation----------=------------------Property Line------------------------------- ---� P a SEEPAGE PIT [ ] "Depth--.------'-- -_-Diameter------------- ❑ ❑r ""- ---Number_--' --"- Rock Size_ Rock Filled Yes No GG WaterTable Depth--------- ----- --------------- ---=--------- --------------------------T------------------- - Distance to nearest: Well----------------------=--------------------Foundation----------------------:`-.Prop. Line--------------------------.. . REPAIR/ADDITION (Prev, Sanitation Permit#--------------'----------------=-------=-----------Date--------------------------------- =----- ----) --------------- .:a Septic Tank {Specify Requirements)----- ------- • -------- -------------- ----------- =------- -------------------------------- -------------- Disposal Field (Specify Requirements)---:- --- - r z i - l --------------------------- ` (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that-the work will be done in accordance with San Joaquin„County .� 1 f Ordinances, State Laws; and Rules and Regulations of the San Joaquin Local Health District. Home owner or licensed agents signature certifies the following`' x "I certify that in'the peq6rance of the work-for which this permit is issued, I shall not employ any person in such manner us" to become subject to o man's -Competion laws. f. California." Signed-=-----Z)c- 4111-1-- -` >� .� --Owner ' BY ---------------- = Title' (If other than owner) i FOR DEPARTMENT USE ONLY a APPLICATION ACCEPTED BY-------C . = --------- ----DATE_- - ------ ---- ---- ------------------ ---------------- : BER- - -- ---------------------• ---- ----------------_.-.-------- DATE - I ADDITIONAL COMMENTS----------------------- --------------------U---------------------------------------------------------------------------------------- ------------------------------- DIVISION OF LAND NUMBER. I ---------------------------------------- -------------------- ---------------------- - - : - I { ------------------ Final Inspection by =. =----------- ------------------------------- ----------------------- Data i EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT r&s 2167 Rev. 717e 3M