78-268 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: FOR OFFICE USE: PPLICATION FOR SANITATION PERMIT ---------------•--------- ....... ..........-- --••----• ------..... '_[Complete in Triplicate) Permit No... _^ �__— - Date Issued.,..,/. .'.7 ................................ ----- --------- ---- This Permit Expires 1 Year From Date Issued Application is her y made to.the San Joaquin Local Health•District fora permit to construct and install the work herein described. This applicatio is made in compliance with Cou ty Ordinance Na. 549 fisting Rules and R atiions, JOB ADDRtS /LOCATION... . A�andd -------'5_-.CENSUS TRACT.-.......... ----_--- - Owne ame..... .._.... i>Q� -----Phone------------- Address------- ....... ... 6:-✓..G ?Z - CitY----------- -- -------------------- --- Zi Zip...... ........... Contractor's Name. License #.��Q. � �. . -Phone... _ 1 �`f Installation will serve: Residence,X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other----- ----------------- ...................... Number of living units;....... .....Number of bedrooms..... Garbage Grinde-r............Lot Size.....orwwA... ------- .- Water Supply: Public System and name-- -------------------- -- ---------------Priva,6,1_ Character of soil to a depth of 3 feet: Sand ❑ Silt ❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam Hardpan ❑ Adobe ❑ Fill Material . ..... ....If yes, type---------------- I.............. (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc, must be placed on reverse side.) NEW INSTALLATIOW (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ l SEPTIC TANK [ ] Size ... .. ._. ---A_./.®_.................Liquid Depth. -------- Capacity.//P.00.....Type..-�_.-- --.---Material. d- -------------No. Compartments-.-;7. --- Distance to nearest: Well-----.0-0................ .........Foundation....f.Q. --------.. ..Prop. Line.... E�t......------ LEACHING LINE [ ] No. of Lines yy,r�� ------------------ Length of each line-_---9_6............_Total eLenh ..`__,70...___..__.............. 'D' Bax..I......_Type Filter Material------ Depth Filter Material-- ___-/ ....................................... lei N Distance to nearest: Well--/Ore? .........----Foundation_._t!Q�T--------------Property' Line------6.... SEEPAGE PIT [ ] Depth.__9..5�_Diameter__.,-7-?. — ___.....Number....__. __1----------------- Rock Filled Yes No ❑ Water,Table Depth.-------------------- ------ ----- --_--..Rock Size.- � r1 Distance to nearest: Well------� - ----------------------------- Foundation.--ice$---.. ._ .-.Pro -Line-- --.------� REPAIR/ADDITION (Prev. Sanitation Permit#----------------------------------- ---------------Date.....................-....---....__------ _) T Septic Tank (Specify Requirements)...................... ....._........ .................. 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 Caun% Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licensed agent signature certifies the following: y "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 Compensation laws of California." r Signed.. --- Owner .......... ..... Title.-- ...... -------------------- (If other an ow er) t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-._:. .. .. . . DATE ''DIVISION OF LAND NUMBER.. -- -------- ----- DATE........----------- ....... ------------- -. ADDITIONAL COMMENTS............. . . .._._. ........................ `Vol - __._.....___._•.__......... ..... .._._-._ ...._..... -�a. .; :.__..:_ �,-7� - - - -- - ----------------- --------- ------ -- --- ---- -------------- --•------ --------- .. ..........-- ----------------- ------ --------- ----------------- -- .... -------- Final Inspection by:.. ..... rt�2 ---...Date.---------- - EH 13 24 SA JOAQUIN LOCAL HEALTH DISTRICT FaS 21677 REV. 7176 3M