77-620 - Laserfiche WebLink

Home Browse Search

............. li FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 77_ 'X Permit No-------------- --- -------------------- - (Complete in Triplicate) _ Date Issued".�--------- i This Permit Expires 1 Year From Date Issued d install the Application is hereby made to the Son Joa Joaquin Local Health District for a permit to construct on and existing Rules and Regulations:work herein described. This application is made in compliant Y CENSUS TRACT---------- ---- --------------- N JOB ADDRESS/LOCATI Phone --------------------- -------- - - , ---. Owner's Name-. -- P --------------- - ------- I city Address---- �....c.,•! r - License one-------- ----- Contractor's Name---- - u > 0 =Trailer Court ❑ Installation will serve: Residence Apartment House. Commercial - i: . Motel ❑ .,Other-,--------------------- - ------' = f c 1, Number of,living.units:_. - = ti ' __Number.of bedrooms____ �Garbage.Grinder_____,____._.LofiSize_.____.-•. _. - y ------ - Private ' ---.------ ------=------ --------------- Water ------------- - Y Water Su I Public System and name-.,._____._:" PP.Y Y Character of soil to a depth of 3 feet: and ❑ Silt ❑ Cf6ay ❑ 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.) �! t p itted ` available within 200 feet,) NEW INSTALLATION: ..(No septic ank or see yge pit peSrz if public sewer is ! ,1/ : ' - � � .�-.�' - _ Liquid Depth...-V ---------------- PACKAGE ---- ---- ---.� p , 't SEPTIC"TANK '[ ?� - - PACKAGETREATMENT 1 l .; ii '� A , .�►'� , ��.. - m . No. Compartments _-____--�'---------------- � fMateri ral Capaety)�4 Ty near — s = Prop. Line eFoundation - a Distance to *- , E . _"..3 -- ---.--- Length�of each lino _`� --_Total.Length ` � LEACHING LINE [ 'No. of Lines_ ' r 1 r 'D' Box----f.------Type Filter Material----::4 ----Depth Filter Material-;_-------f ., ' - ------------------- -Distance -- - ------- i �y � .Pro Property Line___ .- --- ' _Distance to nearest: Well-:__ -D.4--f- ""- _._Foundation____ "-- t., P itY ss� �� r Number---- --_---- -� Rock Filled Yes' No SEEPAGE PIT [�1�,. De th _,e�__._.--.Diameter__:--- _ _ . . t P .9: -_ . . ------------- . ,,,,. - ,,, , r/ . ""Rock Size---- - _� - 3 , Water Table DepthQ = =- --- -- -- Distance to nearest:Well-__..-- -- _ `:-.------ Foundation__-.- -- --------- --.Prop. Line------------------------ Distance ------ -- -- 1 / n ► -�.y. . =---.Date------- -t "" " REPAIR/ADDITION (Prov. Sanitation PerFnit#--------- -----;------_- Septic Tank (Specify Requirements ------------------=- ----------------- ' - = ---------------------- -=---- --- Disposal Field [Specify Requiiements)----------------------_------ ------------------------ ----------- - -- - i - -------- ----- - -----------,-----'------------------ - 9 •require -- ------- ion on reverse side) r i thiDsra I i`ation and thatthe work - I h�reby certify that:I have preparedpp will be done in accordance with San Joaquin County 1 Ordinances, State Laws, and Rules and Regulations of the' San Joaquin Local Health District, Home owner or licensed agents - 9 f signature certifies the following: 4 "l 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 Com nsation laws of California.". ! . Signed ' Owner r 't1e- (If other than owner) I FOR'DEPARTMENT USE ONLY µ DATE._- ----------------- ---------APPLICATION ACCEPTED- BY (- ------------- ------ = : . DAT DIVISION OF LAND NUMBER.-___----__. -". _ ----- . -- ----------------------- ADDITIONAL COMMENTS------------------- --------------- --- ----------------------- ----- - - ---------------- ---- - ---- -------- 4 ----- -- -- -------------- -------- --------------------- -- - Date --- A -- Final Inspection b --- -- Fos 2i6» Rev. /�6'" LTH DISTRICT EH 13 24 SAN JOAQUIN LOCAL HEA