79-333 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT .,/ .. (Complete in Triplicate) Permit No. ................... This Permit Expires 1 Year From Date Issued Date Issued .. Application is hereby made to.the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordin 549 d xisting Rules and Regulations: JOB ADDRESS/LOCATION. .. 52Z.......... ...".... -E6 iM.Q .CENSUS TRACT....................--.......... Owner's Name.... . \.1.1-D - V .1AN-fes-... PhoKe Address....... ._ .gr...-. 1..�..Cly.D -------ST---------- ---... ----city--.t- ?..�1.......----- �_... ZIP ��J�$Z C7 Contractor's Name- ------ ------ .. ...... . ......License #. -- •-------- Phone---- ----- .............. ------- Installation will serve: Residence ❑ Apartment House ❑ CommercialA Trailer Court ❑ Motel ❑ Other.......... ........ e----------------- ----- R Z Number of living units:.....d.......Number of bedrooms-.O . .Garbage Grinder----.-.--._Aot Size._�, .. .-......:........:>;.. _ r �J � Water Supply: Public System and name.... :..~.:.- ---------------- --- -- ,-------.Private . ------------------ _ Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam Clay Loam ❑ Hardpan❑, 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 reverse side.) .� NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANKSize. -- -- . . -�+-.-X.--- -O"--�-------Liquid Depth.---- .- i........ [ ] . Capacity-�Zco..V444.Typ -L/ .......Mate-rial..?-_ -—No. Compart.ments<::-----�------- .... .......... Distance to-nearest: Well---------vad....... ..............Found ation."--- -1--r-*� 7,Prop:-Line-:- ?-_........_-------.. LINE- [ ] No. of Lines .--"---- -----------------Length of each ine ..-" 40........... Total Length .. . Q-_.--.-_-...-".....-"- �;�M I N 1�}�ll9t vr% � �r ? rt ( - Type Filter MaterialL�-� dp �.. 'D' Box_ :' T t alter Material...-- �----� --- ----------------- ---- ------------ Pyt cti L 1 Distanco to nearest: Well-------t 0 ...........Foundation------- - .---. Property Line....-PIT Number---------- -_SEEPAGEa ^r. { ] Depth.-.. .- _-...--.... """"-- f --`Ro4f4 Filled Yes No E]SEEPAG ?- Water Table Depth. ` � ------------------------------- Rock Size.- iCPh--/�Df Distance to nearest: Weli-__{-,'�O.............................Foundation.-M 70L—...........Prop. Line", ._T '....._.--. REPAIR/AD +TION (Prev, Sanitation Permit#--------------------- ------ ----------Date--..----------- .---------------------------- Septic ------------ ..----.--.--- Septic Tank (Specify Requirements).-.. . " Disposal Field (Specify Requirements)----- ... ..................... •---------- ----- _---------- - ---- --- --------- --- ..... - - - ..-------- - � .., ----------------------- - (Draw existing and required addition on reverse side) 1�` I hereby certify that I have prepared this application and that the work will be done in accordance %rilh 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 certify that in the performance of the work for which this permit is issued, I shall riot employ any person in such manner as to become bject to Workman's Com ensation laws of California." Signed - . . -----Ownex By-•------------------------------ ---------- , - ----------------------------:.-,Title - -- (If other than owner) - t FOR EPARTMENT USE ONLY APPLICATION ACCEPTED BY.... t .......DATE - . ..� .... DIVISION OF LAND NUMBER.... ..................................... .. . . ------------------------DATE----------------- ------- ----- ADDITIONAL COMMENTS. --- . . . - -- -------------------------------- - -- ---- ---------------- ----------------------- -------------- - ----------------- ------ . .. ----------.................. ............................................... --------- --- ---------------- ---- ......... ....."� ------------------------------------------ ------------------- -----------------I------- .................................. --------------------------------------------- ----- ....... ....... .. . 2 Final Inspecflon by: G l��f Qate. --�,'__;' -- . �� ....... EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&S 21677 REV. 7176 3M