77-299 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: FOR OFFICE USE: s ---------------I1-------------------------------- - APPLICATION FOR SANITATION PERMIT Permit No.77 l {Complete in Triplicate} --------------------------------------------------------- Date Issued".- _-._`/ .a- ---------------------------------------------------- This Permit Expires 1 Year From Date Issued t 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, x �... ' ,f Ar/ IV JOBCTADDRESS/LOCATION � � - ----- ----- ---------------- ---------- CENSUS TRA Owner's Name ---- =- -= -----i----- - - _ ---_.Phone L -------------------------- s I Address. ..---- , Q- fl '�{ LFV; _Cit ip- - Contractor's Name- --- �"--i-'- - ---- ------------ s ens - on ------------- .Lic e # ,-2-z 3 Phone E/ t Installationwill serve: Residence V. Apartment House.❑ Commercial },.. Trailer Court. ❑ .. ' Motel ❑ Other/ :..- : -_ "r- + l Number of living units:_ -- - Nu tuber of bedrooms ..o--.--Garbage Grinder-.--_-l_Lot,Size-..-.--_ -" ------_- ---------- -{" Water Supply: Public System and.name-------_ "-"..-.. ' � � � � Private ❑ a 4 Character of soil to a depth of 3 feet: F Sand [] 'Silt� Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam ❑ + Hard an D Adobe_ Fill Material -------....If yes, type---------------------------- ---- (Plot plan, showing size of lot, location of systems in e_lation'to wells, buildings,�etc, must be placed on reverse side.) ' NEW INSTALLATION:`- (No' septic tank`or seepage'pit ipermitied if public sewer is available within 200 feet,) PACKAGE TREATMENT ['] SEPTIC TANK [ ] __-____.-.._-°-___ _---__-_- _"-"-- Li -- .- quid Depth-=--------------------1 Size--- }J = r � c _ Capacityl'•------' =-'=-"= -':Typ? k' Material ---'- `�," ":-No. Compartments]----- ------------------- ------ .'Distanceeto nearest: Well--------- ----- --------- ----.- _-.-=Foundation._:--------- f:---- Prop. Line-=----------------------- ----- ------------- I No. of Lines--.------;. Len th of each,.ki•nEs. -----------..TotalLength ----- LEACHING LINE: [') -------- J - D' Box..............Type Filter Material- - ---.Depth Filfer Material----------------'------------------------------------------ - Distance_to nearest: Well------ :--- -----Foundation.""--------- '----_-:.-..Property Line--------- ------------------ F - - -- SEERAGF PIT [ ] Depth_- Diameter- "--.-___Number___--- ------ --------------- Rock Filled Yes❑ No Water Table Depth----------- - =--------------- -----------Rock•Size--,- --------- ---- �------------ k ! .to nearest: Well-----------------------•------:-------------FoundatioF----- --------------------Prop. Line-----------------------! REPAIR/ADDITION {PrevDSanitati -Y--�-- -- —Dote_ - -- - — ----} s on Permit#------ �� ---------•-------- - - -=- Septic Tank (Specify Requirements)--.-L..-----------_ ---- ------- =----------------------- -------- -------- - ---------------------- ---- -------------- - - kr= ) : - u " �--------------------------------- -------------------Disposal Field (Specify Re uirements -- ------- - --- ---- --- ---- -- ------- A I t i (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: r "I certify that in' the performanie-�of'the"work for which-this permit is issued, 1 shall not employ any person in such manner as to become�ct to Wor man's CompensationF.Iaws..of California.". --.. - Signed--- +--- ----- --- ---------- . ------- _ _ . . .- . . = Title_ = f---- BY=------=------ - ---,-- ---:----- - ------------------------------- N I (if other 'f n-owner)" ° } /:: ,FOR DEPARTMENT USE ONLY" i J -77 APPLICATION ACCEPTED BY'. •�'� -------------------- ------------- ------ D;4FE- = - DIVISION OF LAND NUMBER---------------- _,__--.---. --I..-- ADDITIONALCOMMENTS-----= ----- -------------------Y-�------------------ `----- --=---------"-------------- -- -------------------------- - ------ - -� ----- ------ = - , :/ -- ----------"- --------`------------------------'- r ----------------------------------".-- - - .---_-'______-" -: _---._-----------------------------_-----------------------------------__----_-------- Final Inspection by:.-- - - ----- --------.:-------_Date__. '�- ------- --------- EN 13 24 SAN JOAQUIN LOCAL.H.EALTH DISTRICT——1�- F&5 21677 REV. 7/76 3M