78-742 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: (A FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Z Permit N ermo. ,T-_-744_c� (Complete in Triplicate) P Date Issued_.11-3/--79 ------------------------------- This Permit Expires 1 Year From Date Issued ' Application is hereby made to the Son 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: ---- . F � 1 ---- -- CENSUS TRACT.----- ----------------------- - JOB ADDRESS/LOCATIO ---:------ �----- ameOwner's N ------ ----- 1 `. C�-- ------Phone------------------- 1 Address.--_-_ •�-t' 2Cc r :_� . :City----- -------- ZiP -- " */_!d ,-- _License # _Phone ntr Coactor's Name------- _ _._ Installation-will serve; Residence Apartment House,0 Commercial E) Trailer Court- E]• > ----Motel ❑ Other----------- ---- ------ .. . _. Number of-living units:_ > .. -----Number of bedrooms __ Garbage Grander Lot Size:------- -�` 'ti:`.� _. ___-- Water Supply: Public System and name :_------ ------------ --=-----'----------------.:---=-- --------------- - ------ -__-:_..-------------.------Private [� Character of soil to a depth of 3 feet: Sand [] Silt [-]":Cia`y eat ❑ Sandy Loam ❑ Clay Loam ❑ Y � . . . - Hard an " AdobeMateria-17.7"--If .�.�,.__. . • p ❑ Fill --� -=---- yes, type- -=--------------- ------------ (Plot plan, showing size of lot, location of system in reldtion to'welis,.buildings,�ekc..must be placed on reverse side.) NEW INSTALLATION: (No seP tic tankor seepage P Pg P :' see ; it eraLiittedf-public sewer is available within 200 feet,) i PACKAGE TREATMENT [ ] SEPTIC TANK I l Size-----:----- ---- -----------i----------_--------Liquid Depth-=------------------- I--- Is - Capacity .. TYPe ---- Material ?, No. Compartments--- - -------- ------------ 4 Distance_to nearest: Well --- :-------..-- -Foun1dation -1____..___ Prop. Line---------------------- -- LEACHING LINE [,], No, of Lines.:—--- each line....__:__ �_--- _'.._..Total Length 'D' Box-.:----- -Type Filter Material-------- '--------Depth Filter-Nlaterial--------------------------------------------------------------!----0 Distance;to nearest: Well_;-------------- ... ....Foundation---' ---------------- --.Property Line-.---_-_._-.__________.___-:_._ SEEPAGE PIT [ ] Depth----------------Diameter---------------:- --Number-_ - ----- ---- __ -` Rock Filled n Yes ❑ ' No'[] i Water Table Depth- - ------=------=------`------ ---------------------------Rock Size--------------------------------------------- ' Distance to nearest: Well -------- --------- '' -___-..Foundation--:--------1 =__.Rrop. Line---------------------------. REPAIR/ADDITION (Prev. Sanitation Permit#--°______________ _______________ ____'___ _.. ` ,\______- ) Septic Tank (Specify Requirements)--.- ------ - = - �� ' ----------- gg Disposal Field (Specify Requirements)' ---_--_----_-----_---- - --------------------------------------------- --------.-A-- ` - - - t ---------- ---- -- (Draw existing and required addition on reverse side) - > r I hereby certify that I hbie.prepaed`this application and that the 'work will be done in accordance with -Sero Joaquin County Ordinances,- State-Laws;and-»Rules--and-Regulations--of--the-San-Joaquin-Local-Healtl Diitriit;Home owner�or`licensed agents signature certifies the following: "! certify-that in the performance'of`the work for which this permit is, issued, I shall not employ any person in such manner as to become subject to Workman's mpensation .laws of California." Signed = Owner. By ----- - Title- ------------- ---------------------- r Lti� _ -LCf ems- (If-other than owner) r I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED; BY ---------------------=--------------------------'---DATE.---- - 7 - DIVISION OF LAND NUMBER----------------- ---•---------------- - ------ --- DATE.-------------------=-----------................... ADDITIONALCOMMENTS---------------------------------------------------------------------------------- --------- ---- ----------------------------- --- t f __________________________________.-______ _._ _.-__... _ ----.-______________ .__ ____ ..___ _____._ _ y . Final Inspection by Date----- ------ -- ------- ' - -- - --= - - ---- EH 13 2a SA7JAQ UIN LOCAL HEALTH DISTRICT res 21677 REV. 776 Sea