77-936 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION P � � Permit No. ..7.7:1�.��.. ....................................... (Complete In Triplicate) This Permit Expires ! Year From Doh Issued Date Issued f.�'z s�.7� Application is hereby made to the San Joaquin Local Health District for a permit to constnict and install the work herein described. This application is made In compliance with County Ordinance No. 519 and existing Rules and Regulations: JOB ADDRESS/LOCATION ... ..`.��.� V... J ��....._.:........................i'.!!...........CENSVS TRACT ............................ Owner's Name ................1!GZ U .�l Lf1.... lT..b.IY......... ............... , ................................Phone Address ............................_.. ........... .....................I......I..................City .. ...........`^..... ............................................. Contractor's Name ............................ .............................................License # ........................ Phone .._........................... Installation will serve: ResidencegApartment House❑ Commercial❑Trailer Court ❑ i Motel ❑Other_ Number of living units:........V Number of bedrooms ....Garbage Grinder ....`P... Lot Size ...&SO < ccz5: ... Water Supply: Public System and name ........C: �s:.�.. ..........................._.......................................... !•rlvaM❑ Character of soil to a depth of 3 feet: Sand E3 Silt❑ Clay ❑ Peat❑ Sandy Loom❑ day Loam ❑ Hardpan❑ AcloboA Fill Material f yes,tyP!............... ............ !Piot plan, showing size of lot, location of system in relation to wells, b sidings, tc must be placed an reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public is liable within 200 feet,} PACKAGE TREATMENT [ ] SEPTIC TANK Size.................. Liquid Depth ........................... ... ................9 CapacityType .......... ........ Material.. 11.... . No. Compartments .....�.........ay Distance ��rewst-.--Well ........ . ............Fosindatlan .............. Prop. Line .... ...--..-.s LEACHING LINE No. of Lines ........... .I.......... Length orf each line. __..� � . Total Len ....... ........(�'� 'D' Sox ..... Type Filter Material�l .T ePth Ft tiY sterid) ......F.. .<.h. ...`Ib� ; Distance to nearest: Well ....../.10LI.. nda Ion .... ..... Sporty Line .. .. .�+ i SEEPAG PIT Depth ---i Diameter TX_ .. mbe .. ...... ......... flock Filled Yes �No ..*5 star Tab a Depth it .. ..R Size � 4 stance to nearest: Well -------- ...............Fo an ............ ....... Prop. Line ............../........ (� ` REPAI DDITION(Prov. nitotlon Permit# ....... ....... Date ................................ .) Sep is Tank Specify Req Irements) .. ... ... ........................... :...... ..............................._................. Dis s I Field (Specify R qu€rement ) ':..._ ...... --••\........... .............. .... .......I................•--------• ................ .....•........................................ ......... ........................................... ............................................. ......................... ................ -A................................ ..._............_._.................------------.. i Dr w existing and required addition ever side) t hereby ertlfy that 1 have preps nth s application and that the w wi be done In accordance with Sara Joaquin County O finances, State Laws, a Rule and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents gnature certifies the f lowing: ' "I certify tho n the pert an of the work for which this permit Is Issued, I shall not employ any person In such manner as to beco s e t o n's Cam ansaIaws of California." 5� gned .......�_/"-6 . ...... ..................... Owner By ............ ........ . Yitle .........................................................•.............. pf other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -------------- y --- .._....._. DATE .. � .-z.�?..... T............_ BUILDING PERMIT ISSUED ......DATE-.:.......................................... .......... ADDITIONALCOMMENTS ....:........................... . .......... ............................. I........ .........-..------•---•---- .... ........ .. ............................. ... ._. _ -..... ...... .... .- .. . ... .f ................ ..... .... .....................................I............................................. ........................................ ....... Final Inspection by: Date ... ...... ..........._....-.... ---........ .............•-- EH 13 2h 1--68 100 SAN JOAQUIN LOCAL HEALTH DISTRICT 8/721 3M