78-923 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: FOR OFFICE USE: OR SANITATION PERMIT APPLICATION F Permit No.7Y--- . d1 -- ------------------ -- (Complete in Triplicate) Date lssued'/'I--=/�=L This Permit Expires l Year From Date Issued, ........................ ----- --- ----------- 49 and existinthe g Application is hereby made to the San Joaquin Local HealthDistrict for a permit to Rultes and Regulatruct and ions: work herein described. This application is made in compliance with County Ordinance _ w�. r CENSUS.TRACT.._.---------------------' -- % i JOB ADDRESS/LOCATION --NA ,S ------------------ ------------------------- Phone - ' . Owner's Name_. City_40 - ---------------- - --------'------; Zip Address_-.-- ----- ------------- ------------ - ---. ---------- �.:_...,. icen -------- .;.;Lone :- ------ ------------ L' se # 3z P Controctor s Name---------- --- -------- - r , artment House.] Commercial ❑ .Trailer Court' ❑ , Installation wiII serve. Res+dente [ AP 4, ,i.. Motel E-1 'i.- other '= - Number of living units:._'- ------Number of bedrooms._.__-YGarbage Grinder_ _'.:Lot Size.- ..-°-- vat i -------- ------ ----- Pri Water Supply: Public System and'name----;-,..----------- ----------------- Character of soil to a depth of 3 feet: Sand ❑ ilt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan E] AdobeFill Material-.._ . 71 yes,type..-=__-•-- -------------- i buildings,:etc. must be placed on reverse side.} ' (Plot plan, showing size of lot, Vocation of system in relation erronwedsif public sewer is available within 2�0 feet,) j NEW INSTALLATION: (No septic tank or seepage p P _ i i Depth�.. » -----------Lquid De t - - --- r PACKAGE TREATMENT [ 1 SEPTIC TANK s[ ] -�»-----� ize - Capacity_-:--------= `= ' - YP. ='= -- -..._Material }No. Compartments._ --- - ------ --------- t Pro Line______-- T e - Foundation-I----- ;__ - p' G nearest. Well_ ;.: -- = t fi No.of Lines. Distance'to n :`=---Total Length.--------.: ----------- ---- c f line.--.------_- _ LEACHING LINE [;] . Yp --,- D' Box.------- -T a Filter Material----------------- Material _ f Q --.----.--- ------ ------==--Len,gth.o# eat _: --=----------• --�-_-- -----;-- --- ------ -.- . ., • Y_Depth •, .� _ _ , i -- + undation--- ------------- Property Line=-_-- 'Distance,to nearest: Well = = Foundation :... ..r.......,._ t Yes'[] N ' _., h Diameter.< Number --------------------------- Rock Fi 6 SEEPAGE PIT [ } Water Table .Depth..-------- ---- .--------------- ----------------= ------ -Rock Size------ �-----; - ---. ------ ----- t Depth---- ' Foundation ------ --------R-.Prop, Line Distance to nearest-kWell_- *_�" . ---- -------- F -----Date------- ---- -------------- -----) REPAIR/ADDITION (Prev. Sanitation Permit#.-;_---= :--------" ------ ---------- . -- ---- ` -------- =--- Septic Tank (Specify Requirements) l ""'i l Disposal Field (Specify Re urrementsl.___- --' - ----- ----- --- -:- • -- _------------------. - - -- - .-. - - - ---_-------_ i ... .. -.c. - .._- .. ... -.. ". --. �4 t (Draw existing and required addition on reverse side) ` l hereby certify that.) have prepared this application and that the work will�be done in accordance wiFh San JoaquinCounty Ordinances, State Laws; and Rules and Regulations of the San Joaquin Local Health District. Home owner or licensed.agents signature certifies the following: erson in such manner as "I certify that in the performcnce of.the work for which this permit is issued, I shall not employ any p a y to become subject to Workman's.Compensation laws of California.". _ Owner Signed-= --- -=---_------ e - --- ------- --------------- �4 By - T itl Y __.:. , - (if other than°owner) - FOR.DEPARTMENT USE ONLY APPLICATION ACCEPTEQ BY_- r----- - - --------------------------- ---- ------ ------ ----- ------- -DATE...- DATE DIVISION OF LAND NUMB =, -- -------------- ADDITIONAL COMMENTS------------=------- ---- ------------------- - = --- ----------------------------- - - - - ------ ---- -------------------- �' ..___ ---- Fos 21677 aev. 7/76 3 Final Inspection-by:- EH 13 24 _ SAN JOAQL1lN LOCAL HEALTH DISTRICT r F- -