77-845 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: i APPLICATION FOR SANITATION PERMIT FOR OFFICE USE: ---------------------------------k________--------_.____. (Complete in Triplicate) Permit No.. '�y`� _� k -- -- -----=--------------------------------------- k - __ This Permit Expires 1 Year From Date Issued Date Issuedd--_--- ---l7 i Application is hereby made to the San Jo q in 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 i JOB ADDRESS/LOCATION. -7_-s] ------ --- 4-A --- US TRACT a ------- '------------ GENS a! Owner's Name--- ------ _e _ ---------Phone Address---------- ; City -��7 -' Zip Contractor's Name L e ; --- is nse � � - ;--- � + _Phone---------------- Installation will serve: n A Residence - Apartment House.0 Commercial ❑ Trailer Court,❑ i t ,. Motel ❑ Other- Nu:mber thec--Number of living units:.-'-_-f-------Number of.bedroom s_.__ _.__Garbage Grinder._.._-_. ----Lot.Size----._..,,._,_°___ Water Su.pply: Public System and name----------- ------- ; - P ------ ---- - Private (� Character of soil.to a depth of 3 feet: ; Sand ❑ :Silt❑ Clay ❑ Peat ❑ Sandy Loam 0 Clay Loam :. ❑ Loam Hard an II Material__._:__..._lf yes, type_-:L—__ �--_------ p ❑ ' Adobe 'Fill (Plot plan, showing size of lot, location of,system in relation to wells, buildings,.etc.must be placed on reverse side.) NEW INSTALLATION: .(No'septic tank or see age=pit`permittedif~public sewer is available within 200 feet,] PACKAGE TREATMENT [ ] .k SEPTIC TANK ! ' y� ' j Size ----- '(€ . _ __ . 7— Li quid . ------------' , Ct• s-!Capacity' =TYPe- ---- Material. _No: mpartments o 152------------------------- Distance ---- -------------Distance to nearest: Well ---------------------------Foundation- ---- ------Prop. Line------6------ Length of eac LEACHING LINE [6 No. of Lines-------- ----------------- - h_Line; ==_..Total Length.---------- - - D' Box._:__ l---'-'T a Filter Material__.___ _____De x,. ---------------------------- 1 YP `h Fitt eria ___-- ---:- p er Mat I4. -. / Diameter_: Foundation -+ ----- -- --------Property Line-------�- Disptbnce.�o ri�rest_ Well-�-- ---' � - ; •- -' - ; . - � � ..._#._.. �.. ..� .Roc --�--- 1 Depth SEEPAGE PIT Y p ----Number---=--------- ------ --_-_ i 'k Filled Yes ( No ❑ Water Table:Depth' f-p j Rack Size-1,E •_ . r { Distance to nearest; Well.__------ --- -Foundation -tO- r .Prop. Line.---- ` REPAIR/ADDITION (Prev;Sanitation Permit#------- ----------------------- _____:Date_________________________ -----.---- _ Septic Tank (Specify Requirements' -------------- --------------------- - I Disposal Field (Specify.Requirements). - '- . t . ----------- ------------- ------------------------------------- ----------- ---------------------- --- -------------------------------- ---- : -: ---------------------------------------------- --------- (1]ravv existing and re u� - - - --- -- --- - -- - ---` --- -- ,r -- - - q -red addition on reverse side) l { I hereby certify that 1 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 signature certifies the following: "I ceM that in the - fy 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 Compensrition laws of California.'..'. ----------- -------------- ----------------------------------- ----------- ----------- - --Signed-= BY Title_,:6 i (If other than owner) F ( 'FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-_--- 111110F DIVISION OF LAND NUMBER----- DATE -------- --- ---- ----------------- -- ---------•----..:------ ------DATE-,-----------_----- - r ADDITIONAL COMMENTS________________________ -------------------- ------------------------------- ------------------- 4 � _________________________ ___________________________________________________ _ ___ ____ _______________________._--.--______----------__:--__.___------.____--_--_______---._-___-.__--_-__--.___.__--__-----_-.-._______ -----6-----------`--'---------------'- .. ___ ____________ Final Inspection--by: -. " ' - -Date EH is sa SAN JOAQUI LOCAL HEALTH DISTRICT F&s 21e77 Rev. 7176 am .4