77-893 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT �j (Complete in Triplicate) Permit No,77_-9_�__---- -------------------------------------------- ------------ --- Date Issued--lam 7 lQ'� ---------------------------------------- -- ---- --__ 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. 349 and existing Rules and Regulations: I, �/� �[ JOB ADDRESS/LOCATION- Z 3__3____i'�---/ � CENSUS TRACT----------------- Owner's Name ame &....----- ��'-t"��---- Phone Address �� -- ------ G - ---- -- ------- -1-----Cit Contractor's Name-----_.._ " "� License #__ _ - --Phone_____.._________._ Installation will serve: Residence e Apartment House{:] Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units:----------/___Number of bedrooms-----3._Garbage Grinder___---------Lot Size.5r �. Water Supply: Public System and name---- -------------------------------- Private Character of soil to a depth of 3 feet: Sand ElSilt EJ Clay ❑ Peat L] Sandy Loam ❑ Clay Loam E]Hardpan V 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 see age pit permitted if public sewer is available within 200 feet,) " PACKAGE TREATMENT [ ] SEPTIC TANK. f [ Size r�- c -------------------Liquid Depth.-----V---------------� • Nlate.N6I-.�_._-No. Compartments------� ---------------- --- _____._._ Capacity--��a-Q_----TYpe -- ------ - Distance to nearest: WeII._..____---- � __ "r -Foundation_------{_JO_.�-4067__Prop. Line--------f7K LEACHING LINE [ No. of Lines----------- Total Length _F�_� =0 ---_,_ --------__Length of each line..--- ��-� ------- 7 D' Box...... __--Type Filter Material-------- _/P__-Depth Filter Materia-I-._____1 _-___:___. -_ ` n - F ----------V` Distance to nearest: Well---------------D--___------Foundation.------- -- ---------------Propertyline:_..__ --------------- _ ,SEEPAGE PIT [ De th__4Q•f___.Diameter.____3.3_-_._Number__ _____________ p ,�------�----- IILL Rock Fialed Yes [� No Water Table Depth �� = -Rock Size--:� `r'--3 a I Distance to nearest: Well________L�?._I1� Foundation-..___�� .'--__.Prop. Line_____ "f 7 [ - REPAIR/ADDITION {Prev. Sanitation Permit#___-_______.____.______ -----_-----Date------ __--_ �- Je- `Septic Tank (Specify Requirement`s)----------- ------------------------------------------------------ A' Disposal Field (Specify Requirements)-------------- ----- --------------------------------------_ --------------- ---------------- --------- --------------------------------- - - (Draw existing and required addition on reverse side) I 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: "I 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 C6mpensation laws of California." Sign ed - ------ Owner n e --- - J� Y ---------------------------- ----- - J. (If other than owner) 'T ' Title -- ------------------- -------- R DEPARTMENT Ug ONLY APPLICATION ACCEPTED BY---- --- ---------- - DATE. --- ------------------- ------------ ------- DIVISION OF LAND NUMBER.-- --------------- -- ---------------- -----.DATE----- ADDITIONAL COMMENTS__________ ------------------------------- ------------------- ------------------------------------------------------ -------------- - -- ------------------------------------------------------ ---------------------- --------------- -- -------------------- ------------ ------- ----------------------------- ------------------------------------------------ ---------------------------------- ------------------------------ --- ------------------------------------------- ----- --------------- -------- Final Inspection by:----.---- - ----- Date__.-- -- ------------ - EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&S 21677 REV. 7/76 3M