78-1047 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ` IIff APPLICATION FOR SANITATION PERMIT FOR OFFICE USE: _ (Complete in Triplicate) Permit "•-------- ----- -------- ------ --------- I�------- This Permit Expires 1 Year From Date Issued Date Issued.l/-".9.78' t Application is hereby made toithe San Joaquin Local Health District for a permit to construct and install the work herein descri # This application is made in compliance with County Ordinance No_ 549 and existing Rules and Regulations: Ibed. : 4 JOB ADDRESS/LOCATION CENSUS TRACT. --------- Owner's Name------- I ,. - J-- -------------------- --------------- ----- . . . ----Phone q Address --- ----- - ' '� : ---- ciry - - ---------ZiP- License #_ Contractor's Name_.___._ �� - . --- } _ n �r_Motel p ❑T ane' _ , Installation will serve: Residence A artmenf Nouse. Corrimerciai ❑ _Trailer Court ❑„ . ❑ Other--- ---- -------------- Number of living units:._ ------Number of bedroom g - ---Garbo a Grinder----------_Lot Size------- Water - Su I Public System and'name ------------------ ___ "-_ -----------"------ PP,Y- Y i �t- ------------------------------------ -- --------- Private:, of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam _.... `Hard �an .. - ` PI . ❑ Adobe:❑ Fil1 Material= If yes, C (Plot plan, showing size of Idt, 'location of system in relation to wells, buildings, etc, must be.placed on reverse side.) NEW INSTALLATION: (No'septic tank or seepage pit permitted if public sewer is available Vn jthin 200.feet,) PACKAGE TREATMENTEPTIC•TANK [ ] Size_-__-___._ ] ] S` - Liquid bepth--------- ------------- -- ,e Capacity T e.--------=-- E Material---=----t`. = 'No. Compartments-,i = YP i -- 'Distance to nearest: We11:.: = = =-------- ----- Foundation.-° ..Prop. Line )' I LEACHING LINE [ ] Na, ofi�Llnes ._ Length of each line t Length. `• i 4 D' Box _Type Filter Material____ - - b. M . ..� . - ---------------------Depth Filfer Material._Total _ " Distance ton ` [ ] De th.�- eearest: Well-------------"""-- ---.__---Foundation-,.------------:--_ _` Property Line_.-------------------- SEEPAGE PIT ,i P -- _ P .. ]_ R kF11ed Yes No ❑ --.Rock Size_ Water Table Depth --- --- Number-- ----------------------------------------------- _ Distance to nearest: Well ' t II : ---------Foundation-_._-i_-------------- �_Prop. Line--------=------------- REPAIR/ADDITION (Prev:'-Sanitation Permit#._'_____ ---- - Date. eek II: _.) Septic Tank (Specify Requirements)---------------------- - _:---- ,_ Y - ------------------ "-_____-Y._.--------------------------------- Disposal Field {Specify Requirements):---------" -.. _ --- ; - ----- ------ --- --------- - --- -- ------------------------------ - _. _ - _ --------- N (Draw existing and required addition on reverse side) $ ".3 I hereby.certify that I have prepared this;application and that the work will be done in accordance with San Joaquin Co, Ordinances, State Laws', and Rules_ and Regulations of the San Joaquin Local Health District, Home owner or licensed age, signature certifies the following:P _ "F certify that in the'per_Fornianc`e of'the work for which"this permit is issued, 'I shall not employ any person'in such to become subject to.Workman's .Compensation. laws.omanner as f California." Signed------ ---- ------------ • i Chvner -Title. -------Of other than owner) h� R DEPARTMENT USE'ONLY:.. ; APPLICATION ACCEPTED BY_. _ d ----- ---- - ---- DATE..�� ' DIVISION OF LAND NUMBER; : -- ------------------ . --------------=---------:- ------------ = DATE ADDITIONAL COMMENTS --------------- ------------------- ---------------------- - -- ----------- - r� - ------- -- - - ,_ ------------------------------------------ -- _...---- -- ----------- .rt.. �. = - ------ --------------------------------------- ---- - Final Inspection by:._:..- - __ _= ..�_ ----- z .-- -.-._Date..l_ % ------------------------------ ----------------------------------- EH 13 sa SAN JOAQUIN LOCAL HEALTH DISTRICT F85 21677 REV. 7/76 3M ,t