78-50 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT— rt --------------------------------------------------------- P p(Complete in Triplicate) Permit No... ..__ -`----____ ------------ --- -------------------------- ------ This Permit Expires 1 Year From Date Issued Date Issued--- - 7 i Application is hereby made to the San Joaquin Local Health District for a permit to construct andinstallthe work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regu[ations: , IA JOB ADDRESS/LOCATION--- ---------/! `` _ �A UC� -- ___-- b CENSUS TRACT---.------------------------------ I� i . Owner's NameJ U/ = x I� IZA -= -- ----------------------- ----- hone---- --�3._ y Address.-- ` 1 a Ctyt2vJ7TL�G/a ziP - --- . Contractor's Ndme _-----&.. t-.. ! --------------------------- __License # ?•_._ _`_-Phone_. - s..sil� _ Installation will serve: 1 Resideo nce Apdrtmeht,House.❑ Commercial E] i Trailer Court ❑ ❑i R -- ------ k I .�-. tel Other u ------ ---- + i 'Numbe'r of.iliving.units ----------Number of;bedroom _- age,Grindsr____._. .___Lot Size e,.. ---------------------------....... Water Supply: Public System and name__ ---------------------------------- Ifr _ :_ .-_ -__Private . Character soil to a depth of 3 feet: Sand � Silt[:I- Clay {] : Peat❑ Sandy Loam ( Clay Loam E] _ x. -Hardpan ❑ Adobe [:] ';' Fill Mafer�ial_w%_._..._If yes, type-------------------_---.__...j. (Plot plan, showing size of lot, location of system in relation to wells, buildings,.etc. must be:placed on reverse side.) O NEW INSTALLATION: '.(NoF septic tank Lor seepage pit permitted if publi1sewer is available within 204 feet,) PACKAGE TREATMENT.i SEPTIC TANK " 4 [ l _ [ l " " Size-- X--�J-�---------- =--- -liquid Depth •�, `f - r - ------- F �Capacity�r��--------TYPe -�-�r �- Matexial -. ------- --- No. Compament s---------� -- - � - --- st:..,.,e..11 ` Ko� �- !_�PDistancerto.,neare -Foundation-.2d_._ rop. Line t 2v ---------- F77 - -LEACHING'LINE No. v Lines,; _06VLeSngth of each line----------------------_"______--Tota l Length.. l�---____i-__ Jr al o .Depth Filter MaterialD 3ox:_ �__ __.TYa Filter Materi -------------------------------------------- 1 = = = Distacs to. WeProperLine--- ----------------____ -------------Funda 1 SEEPAGE PIT [ ] Depth-- -:---- -_- .Diameter- -------------r----Number---:----------------------------.- Rock Filled _Yes ❑ No ❑ Water Table: Depth ----=--------------- ` ' ---------Rock Size---------------------------------- -------------- I i 6 c Dista ce to nearest: We'11-----"-------------------- _____________Foundation----------------------.---Prop, Line------------------- REPAIR/Ab,DITION (Prev: Sanitation Permit#_{. I_--------------_:Date---------------------------------- ) r } Septic Tank (Specify;Requirements)___..°____ _.'___.._ Disposal Field (Specify Rem quirements)--. -; - -- ---- ------ -- -- _------- t ---------------------------------------- r , t _ s -------------------------- --------------------------------------------- - 3~-------------R--- -- -- - -_------- -------------------------- -- I (Draw existing and required addition on reverse side) 4 I hereby certify that'l 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 Ir signature certifies',the following: : w "I certify that in-th'e performdifti '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 Compensation .laws.of California." Signed------- ----`-{ 111< Owner BY -------=---- �' fz` z = �-moi.- ---- --- ---------------Title.. ---------------- --------------------------- -------------------- (If ----------- ----(If other than owner) FOR DEPARTMENT USE ONLY t " APPLICATI01 ACCEPTED BY- - ------------------ --- - - �.---�---�-- �;�-.--------;�,�:._DATE..--/----�--(�-` ---------------- .. y DIVISION OF LAND NUMBER,."'..-' -- --- ------------------------ -- .------.".....DATE. ----- ------'- ----- - - ADDITIONAL COMMENTS. --' ---_ --- ---------' ----=---------------------- --------- -- --------- ---------------- ----- ----- - ---- --_ ----------- ------------------------------------------------------------------------------- ---------------------------------------------------------------- -'---------------------- - -- - -- - ----------------------------------------------.----- .---------------- - - - - -- VI -----------------------------------------------' '-- - - --- --'-------------- ---------------- — — — ------------ ----------------- -- --------- ------------------------ ---- :-. Final-Inspection by:....... - ----�----Date:.--C - EH 13 24 SAN J AQUIN LOCAL HEALTH DISTRICT Fas 2U77_REV. 7/76 3M