77-1008 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT FOR OFFICE USE: - -�------------- -�------�---�- - ------------ Permit No. -�--7��v.o-p (Complete in Triplicatel Date issued_-/--------- ---- ----------------- --'1;t--- ----- -- This Permit Expires 1 Year From 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 Ordinance No._549 and existing Rules and Regulations: ,-�°�- -�-••-°ter- -; ._ .•-#--;. - ,- � . ._ 141d �e.�JGB ADDRESS/LOCATION._. J _ --_. ---- .--_ -- -------------_. ,Y --- ---- ----- CEN sTR art Owner s Name.__. ZZ7 s" --�r-[wt _ = ........Phone-5? -- ` C .. Address_..--- ---- - - '" - _ r -` itY - zip _--• , ------_----�--- ----- ----------------------- Contractor's Name-------- _ h one ---- - -.._License #_ .J3 �� -P - Installation will serve: &1Residence K Apartment House. ' Commercial ❑ Trailer Court ❑ + ' F Motel -E] -Other . : -. Nulmber.of living units:._,._--------Numbe o bedroams.__ Garbage Grinder ., __'._ Lot Size__ ` a� Water Supply: Public System:and flame- -------- i ----=----- =_-------=------- ---- y-----Private Character of soil to a depth of 3 feet: : Spnd Q Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Of` .., �. --- -T . --� -. I Hardpan:❑ Adobe ❑ Fill Material_-._'__.__ If yes, type------------------------ s s , N (Plot plan, showing size of lot, location of system in relation td wells, buildings, etc.must be placed on reverse side.) 5 NEW INSTALLATION: (No' septic tank i-or seepage :pit permitted if public sewer is pvpilable within 200 feet,] PACKAGE TREATMENT [ j SEPTIC TANK ' Size---------- ___�--------------- ---_Liquid Depth_-__: Capacity'/640==TYpe,. =Material- U�------No. Compartments----- ---------------------------- Distance - � - t Distance to nearest: Well._..___1C10_A------------------- --f_ Foundation..�.,_lQ � -__Prop. Line-.-?-----'` LEACHING LINE [?4 No. of Lines_'.____-- --- g �� r 9 -------I Len th of each line.-:=____- ------ -----------Total Len th.; f�?O- i D' Box-.; Filter Material___ _._Depth Filter Mater.ial__'-_ l -`� _�`- ( T - Distance to nearest: Well-'----l {� -----Founclation----._!6__t"r`'------ Property Line_.Sd. - r r ��. f N a❑ PAGE PIT j Depth--- ___DiameterNumhe .;_ Rot �IIed e SEE -� F F /� Yes o- Water Table Depth.------ -------' -- ------..Rock Size.-- - = 4. j, o _. ! - a``.Prop: Line_-_75----- ---------- REPAIR/ADDITION ------ -- REPAIR ADDITION Prev'-Sonitation'Permit#--__'_-___.._______________ -------- €_. } l - -- - Date- ------- -.------ ! lstance.ta nearest:Well.__:____:___________ - _- o ndation.______-_- Septic Tank (Specify Requirements)----------------- --- - ==----=-=---------- == = ' ,=' ' ----- - --------------------- Disposal Field (Specify Requirements)-------------------- - ., ' --------- ----- ---------------------=--------------------- ----- --- --------- ' f �. t ---------------------- --------------- � --------- - (Draw existing dnd required addition§onl reverse-side) _ s I hereby certify that:l have prepared this application and.-th-at the;work will-be done in accordance•with San Joaquin County Ordinances,' State Laws, and Rules and Regulations of the Sam Joaquin Local Health District. Home owner or.licensed agents signature certifies the following: t "I certify that in the performance of:the wo,W'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." < Signed----.----- --------- --------------- . . ,.. _ �• ,� t I � ts . - -Owner BY _ - - ------------- ------- l -_-- -.' Tit e - ------ -- (If other than owner) + F t{ b i �.FOR-DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- _ _,_, -` ------ DIVISION _ 1 } - - ----------------------- -- -- ---------- DATE = -- _ DIVISION OF LAND NUMBER----- ---- ---- -- ----------------- --------------- : - ' DATE.-'---------------- -- -----: ADDITIONAL COMMENTS------ ------ --- --------- ---------------------- ----------------------------- ` v + ------------------------------------------ - - ----- - = (� --------------- -t Final Inspection-b '�#� ---- -.- -=--- ':----- -r .� ----- -�=- Date-- �.-c�o�"�g:-- EH 13 24 �� SAN JOAQUIN LOCAL HEALTH DISTRICT tsps 21677 REV. 7/76 3M