78-1119 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE:. _ APPLICATION FOR SANITATION PERMIT FOR OFFICE USE: (Complete in Triplicate) Permit No. ------------ -------- -•---------------------- This Permit Expires 1 Year From Date Issued Date Issued.f v 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. 549 and_existing Rules and Regulations. i JOB ADDRESS/LOCATION....... F- ---f ----_- T j�_0_`._ --�C'C'J��- _.CENSUS TRACT----------- ------------ e� . f ----- Owner's Name---��/- ----'�_`l�_�v':..il.�.i---- •-.- . --- - -------------- -------- - Address-----...... ~!' - ---Phone - - -------------------- ------ ------------------- . -------- CoCity. a1J — ------- ----Zip --------------------- - - License � _ ---Phone� �_ J n tactors ame---------------� - Installation will serve; Residence X : Apartment House ❑ Commercial ❑ Trailer Court ❑ r . _.. w. . -Motel..El r - - Orh Number.of 1 ' - wing units:,_- Number of bedrooms__: ___Garbage G,rindar _._.,TLotSize _v�yr Water Supply: Public System and name .'- P Character of soil to a depth of 3 feet:; Sdnd Silt, Clay ❑ Peat❑ Sandy Loam [] Clay Loam RI rrvate l ' t Hardpan ❑ : Adobe❑ Fill^Materia! ..-- ------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 NEW INSTALLATION: ;(No'septic tank"or's'eepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC -TANK"' --------- - t --------------------- -- d -Depth. Liquid . -- -- Capacity_ ----,Typ?=" .i, Material_ ' --------- ------:---------No, Compartments--=-- ---------- ------ ---- [ Distdnce.to nearest:..Well-------- --=------ Lines :.- ---- - ieFoun ddto n Prop ---------- 1 - -------- -_ -- LEACHINGLINE, Na. o{ _ .------------- --.-----Total. LengthLength of each Ty�e Filter p' Box.---- M ---- epth Filter Material_ y----------------.--------- --- F -----------------Distanceto nearest.. Well_ - ` ` iameter ; . d ;unan.__ Property Line---T Depth 1 SEEPAGE P1 -_ - -: ',! .Number_- • # ` \�A'r\t Rock Filled Yes El No❑ r Water Table 15epth � Yi R ock Dlstance'to nearest: Will FounclawSIn ze r. ...... Prop. rp L ------------------ 1TION (Prev. Sanit�tion Permit -- :-.--.Date------------- ----------------- Septic Tank (Specify sRequirements):_ - == IN i i '' --- ___ _ `Disposal Field (Specify Requireme ---------------- ------------------------ --------- ------- --------------- -- ---------------------------------- --- -- ----------------------- [Draw existing and required additio�'on reverse s d I hereby certify that-I have prepcdredthis application and that the workwill be do e_.irf accordance with San Joaquin County Ordinances, State Laws, and Rules_and Regulations of the Sari Joaquin,:Local Health Distract, Home owner or licensed agents signature certifies the following: "' i' Sr a 1 # t f 3 "I certify that in the performance of the work for which this permit is`is ud, 11 shall not employ an r - I } p -- _.____.__ - ¢ PY Y Person in'such manner as to become orkm� 's Compensation, laws .of California.,,, Signed r Owner ` I By- ------ f _ ---- -- - , g :Title # + ` i __ [If othe _Shan owner) t I . FOR:DEPARTMENir ki '�-ONLY,"'' APPLICATION ACCEPTED.BYT___ '� - - n - - -- — ---- ` = = ------------ ---------DA DIVISION OF LAND NUMBER.-- = ---+�----.-( ---- "-• .."' DATE ADDITIONAL COMMENTS_. — --- e.E-- ! . ------------------------------- : .. - = = ------------------------ < - _ ,, ----------------------- - =------- ------------- ----------- Final Inspection by = -- _--. _ .� . ��.. _ _ ------------------------- --------- - ------------ - -----.Date.------O-'f �7= EH 13 24 y SAN JOAQUIN LOCAL HEALTH DISTRICT Fos 21677 REV. 7_/76 au --`�