78-1085 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT [Complete in Triplicate] Permit No._ -��-- This Permit Expires 1 Year From Date Issued Date Issued-/ _-?_='1 Application is hereby made to the Safi Joaquin Local Health District fora 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: 0.11 JOB ADDRESS/LOCATION-../. _ ----- -- ------------- � _ ---------CENSUS TRACT ------ Owner's Name. fnl_lt- Phone I1-Pi 5wl� .� , Address. 1`Y 6 ----------------------------- -------------City_. Y�- Zig <-'✓� �� Contractor's Name .-.. � License #__ �. 4 �7 .✓/, C5 a"=--- �=1-�'�.Phone------ - ----- ----- ---� -� Installation will serve: Residence Apprtment House ❑ Commercial ❑ Trailer Court Motel ❑ Other--------------------- - -- Number of living units-------- -------Number of bedrooms.__.'---Garbage Grinder-___..Lot Size_ Water Supply: Public System and name-------------------- --------------------- ---- ------------------Private j Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat [-DSandyLoam E] Clay Loam [� Hardpan E-] Adobe E] Fill Material"_____ --=If ye's, Type-..-_a+-----------_-_ti (Plot plan, showing size of lot, location of system in relation to.�vells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permifited if public sewer is vailable within 200 feet,) + 0 PACKAGE TREATMENT [ ] SEPTIC TANK .` Size- G t� ----- --------------------- --Liquid Depth-------------------------- Ca acitl6v ------------------------Material -.No. Compartments-----��------ -A P - ---- TYpe--------- Distance to nearest- Well_/C?e�_- -----------------------Foundation Foundation....Rv-1 _ Prop. Line -------------- LEACHING LINE [e Na. of Lines _--------- ---- of each line-------J®Q-------------Total LeQ9th.__._1;2®-6_.-_______-. D' Box---- -------Type Filter Material -1 4'�epth Filter Material._�� ---------------------- Distance to nearest: Well ___Foundation-.--3_d---------------Property Line--A r ------------- SEEPAGE PIT [ Depth.__l�--_____.Diameter-.Diameter__si�_.��_._Number �---------------------- Rock Filled Yes No ❑ Water Table Depth---=--------------- ---- ; ---- ------------------------.Rock Size-- r w ffl�fJ - , Distance to nearest: Well--.-_l----__-- z _---.-____ Foundation----.- -------------Prop. Line.----------------------_ REPAIR/ADDITION (Prev. Sanitation Permit#-------------------------------------------------- } Date .----- ---------------- ---------- ------- Septic Tank (Specify Requirements)--------------------- ---- ------------------ --------------------- --------------------------------------------------- Disposal Field (Specify Requirements)_------------------- --------------------------------_--------_ - - - - -------------- ----------Draw exi 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: "1 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 ub�toor man's CciimPensatlon laws of California." Signed Owner BY--------- --------------------------- -- -------------------------------------------- ---- --------------Title----- --------------- ---------------------------------- --- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ --- --------------------------------------------------- ----------------_DATE 'g DIVISION OF LAND NUMBER -- - ---- t, _ DATE.-.. ADDITIONAL COMMENTS --__---- [ - -------- 3 --F----------- -N------------�-------I Rr.s /�. ------- t--- :N L W_/--1- .-.�' -.----I- .'J---v"_r---L:°4/� +. ------------ -------------- ----------------------------- ------ f --------------------------------------- ----------------- ----------ZH - XDDISTR -- -------------- Final Inspection by:----- ------------------------------- ---- .-Date- ,�0 -�/ ; M 13 24 SAN JOAQUIN LOCAL F&S 21677 REV, 7/76 3M