79-610 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT - CNp in J� Permit1* 1 Date Issued 1170, 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; - JOB ADDRESS/LOCATION. _ .3.©._...51.E 2 A. �3tA,�2_ 5.7zaGk 1 --------._CENSUS TRACT...--- Owner's Name....... 7Th�97f?f�S.._ 12 42R - i...... :..................... ........... A::. __ Phone.. Address ............city.:_. ............. .....Zip--- - Contractor's Name-_ �. PA'e' is v—0?r. Saa/S-- _.__._ 4l ..... ..........License #_�5.�3.��..... .Phone.. _�•!o'.pAP,7- -- Installation will serve; Residence Lj�� Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other__ - Number of living units:.._- ___.Number of bedrooms---------...Garbage Grinder------------Lot Size-----................ . .. . .......................... .. .. Water Supply: Public System and name....... . .............. ......--..........---------------------------------------------------- ...... - ---- ---------•-------Private ❑ Character of soil to a depth of 3 feet; Sand.❑ Silt .-Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill 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 public sewer is available within 200 feet,[ PACKAGE TREATMENT [ ] SEPTIC TANK [ ] '-, e. Size_ :.--------------------------------------- Liquid Depth.................... Capacity----------------- -- Type----------- ...........Material- ------------ No, Compartments--------- ---------- -------- - . Distance to nearest: Well.............. --...Foundation...--- Prop, Line----............ .....--- LEACHING LINE [ ] No. of Lines -------'-----------..__.._Length of each line...... _....................... Total Length ------ . .--- r 'D' Box............Type Filter Material.-.- .....Depth Filter Material------------------------------------------'- i i Distance to nearest: Weil----..-------___....... Foundation----------------------------Property Line---------.......................... . SEEPAGE PIT [ ] Depth.-_ .....Di;ameter---------..----------Number---------- ___________________ Rock Filled Yes ❑ No Water Table Depth---------------- ------------- *..:.- ..---.Rock Size.- ----- -- ---------------- s ._..-* Foundation--.- - '-'_ i- Prop. Line------------------------- REPAIR/ADDITION --- --- --- ----- REPAIR ADDITION Prev, Sanitation P rmit#___':'.: ------ ---------------- Distance to nearest:yWel -,_-:_..'�:_�..Y, - .------•-•-• :;:-; .. - Date----.... .. _ Septic Tank (Specify Requirements]_....-_- i _` _ . - :.. ..._ .:.... . ..-- -- - _ � ......Disposal Field (Specify Requirements) -------------------- -----------. -. :_.. ---------- ........................ .__. ....... ........................................ ----------------- ----------------------------------------- 5 (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that th w k will be done in accordance with San Joaquin County I Ordinances, State Laws, and Rules and: Regulations of the San Joaquin Local Health District. Home owner or licensed agents signature certifies the following: "I certify that in-the performance of the work for which this permit is issued, I shall not employ any person in such manner to become ble t to orkman's Compen ation laws of California." Signed... �.. �_�� .... Owner 7`� BY = .... Title._. .. .. --- �.. Com.- r---- - -- =- -- ----------�- - (If other than owner) ter ; .t FOR EFA MENT USE ONLY APPLICATION ACCEPTED I3Y__-__-.. - 1VWXt . -- ----- ------- --- --- --- ---- ---- --�---- - � ----..DATE ... -- ------. .. .... DIVISION OF LAND NUMBER.............. -.. ._..._DATE......_.__..-__.__.. ADDITIONAL COMMENTS.- ........ ................. ..... ... ............. .... ....... - ------------------------- -- - Final Inspection b - %_ Date.-..--_- y: .......... -------------------- --- --------..----- ---- - ._..---- ----------- - t.-... -- €" is 24 SAN JOAQUIN LOCAL HEALTH.DISTRICT FaS 21673 REV. 3J76 1M a 'r