78-1027 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE. '` FOR OFFICE USE: .. APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No -------------------- - ---- - ------ Date Issued//.:�z2:,_?e ...................-........-------_- ............... .This Permit Expires 1 Year From Bate Issued Application is hereby made to.the SanJJooquin 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: JOB ADDRESS/LOCATION_/. .. � � .. �. / ---- __.CENSUS TRACT _. Owner's Name.........._...-I!. __ .. ----"- - --=-----------Phone7•z , .Z....- Address----- 1 .� Q .... .._ .. .... Ci#y._._ .- LL Contractor's Name-. .......... .License # P h o n e..C6 4--��4q 7--.- - Installation will serve: Residence ❑ Apartment House ❑ om r "al Trailer Court ❑ Motel ❑ Other--,O-- Number of living units------- ---------Number of bedrooms--------- Garbage Grinder--__........Lot Size---- ........... ..- - Water Supply: Public System and name............. =- -----Private, Character of soil to�a depth of 3 feet: Sand ❑ Siltl❑ Clay ❑ #Peat ❑ Sandy Loam ❑ Clay Loam 0 Hardpon 9C Adobe Fill Material.. .... .__If yes, type................................ ' (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on re've,rse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted`if public sewer is available within 200 feet,) PACKAGE TREATMENT µ � _-�.-_. _ ,,``t. E 1 SEPTIC TANK Size _... -.------_ -Liquid Depth._ 7------------------ Capacity !I'M -Type - ---- r ..... Mat erial_.. Com.-_.:No. Compartments------ —..-------------.---- Distance to nearest: Well.:------ .......... .........Foundation.---40 .f...... .. Prop. Line--..§..- �"..._.-._._."S LEACHING LINE No: of Lines _. --- ----. Length of each line.__._T _... Total Length ----------------- - --- ---- r� .. i 'D' Box-,.-. ..Type Filter Material---. C_Depth Filter Material_...---1_�............................. ----._...... -------- D stance to nearest: Well____: 0_'�.....-.Foundation-_:___.G :�: Property Line------- . 1 SEEPAGE PIT ^[�] Depth...Z .:..-Diameter_.-`__,� .�._.Number_-.-'______ _____________ Rock Filled Yes No ❑ Water Table Depth F Rack Sizt� x .l.L. - r Distance to nearest: Well--------- - ........:.....Foundation....[.`.. . Prop, Line.__.._ .. REPAIR/ADDITION (Prev. 5dni#anon Permit#. -- --..... Date= ) Septic Tank (Specify Requirements) :_.=_ - }:..._�:----------- - -• •--- ---- Disposal Field (Specify Requirementsl..." ............ ----- ----------------------------- - ---•L- --------••------ --------- ------------------- - ---- --. . ... - ------------ ----•-- -- ---------... ................ •------------ --- -- _ - ------ -_------------- (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 County Ordinances, State Laws, and Rules' and Regulations of the San Joaquin Local Health District, Home owner oraicensed agents . signature certifies the following: s "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 Workbian's Compensation laws of California." Signed------ - - Owner By- -------------- ----- --- - ------- - . - ............ ....Title. _._._. 4 (If'other than owner) FOR DEPARTMENT USE ONLY . -------- ww �. --- --- - ........ - ----"-APPLICATION ACCEPTED 3Y__: - -------- --------------- DATE........__-------- _ ------ DIVISION OF LAND NUMBER....:_ ----------- ---------- - --------- ADDITIONAL COMMENTS. .. i ...-_.. _ .......... ......... .."..__.-_- _________________--___--_"-_----------- ... -. ..__._-----_--_.-_-_-__-.._--_____-----------"---------.-.--------._.------------.--------------.__..---------_-.--------._......_"._... ._. ..... Final. Inspection by;--_-_� A U1N LO -Date.-- - - EH 13 24 SAN JO Q CAL HEALTH DISTRICT 18,21677 REV. 7/76 3M