77-157 - Laserfiche WebLink

Home Browse Search

--:FOR OFFICE USE: A _ ` z � APPLICATION FOR SANITATION PERMIT FOR OFFICE USE: 5 ' -------------- (Complete in Triplicate] Permit No._.7_�--�5 -- ci -------------------------- ------ ------------------- """ This Permit Expires 1 Year From Date Issued bate Issued..= '7_--- i 3 Application is hereby made to the Sanfl•loaqui:n Local.�lealth Disci-itt-zfdr\q permit to construct and install the work herein described. This application is made in compliance—with County Ordinance'Nlo.549 and existing Rules and Regulations: _ .n.. . _ . .. . � JOB ADDRESS S/LOC TION_I,S77�_..__-"��_ �,�,,,�M -'S7CENSUSfr ---------------------- T A CTi. Owner'sName..... _ ----- -- !Phone... '------- _ - ---- -- - qty ---- Zips, Cotractor's Name___ - � ).. Eicense #��a_ Phone Installation will serve: ResidenceApartment House.❑ Commercial E] Trailer Court_ ❑ s f.• Motel y ; ❑ er - 9 Lot Size_._, i WateNOmb Supply.er f. ivi living �S• stem,and Number of�bedrooms.._ - Garba a Gr.mTder�� a �_ ,/�,�� iy name --- ---- j _ ----- v,ea} ------------------ - -------- ----Private Character of soil to a depth of 3 feet: Sand Sit❑ Clay [] Peal❑ Sandy Loam O--,Clay Loam ❑- .+'; Hardpan❑ Adobe ❑ Fill Material___.: . --ifwY es a a hype------ ---------- (Plot plan, showing:size of lot, location of system in relation to-wells, buildings, etc:gt be placed on reverse side.) NEW INSTALLATION: (Nonseptic tank or see a e l .if public sewer is available able within 200 feet,ppermitted - PACKAGE TREATMENT [ ] ; SEPTIC TANK [.J (Siz , e..__.... - - t 4 ---- - - h iquid Depfh7�- -------- -------------- F Ca acit p, Y/(:;,.CJ--- Type 04J_ =Matwial°(.G�,E2C _ No. Compartments_ . ------------------ Distance nce to nearest: Well.,-- _ . � ---- -" -Foundation. . -----"-------,.-prop. Line. _ J I 1 -: Length of e� ch line. - -- Length : " ry -- -- - Total 'D' Box,l-. .Type�F er Materia i� ,Z;4I�.D pth Filter Material_ :f I -may . . �; -- -- Distance to nearest: Well _- "" SEEP&F�IT ,.-. ... ,� -"]L Y. Property Line [ l D Diameter.. .. .w_ -�� m - b°er �' - ------------------� ..g ' � Rock--�F�Iled'�-Yes No Water Table De th c " _-:- Rock Size FounDistance to nearest`W ---- ----- dation- a ..roy p.�tin�e�-n S I p s ' = --------------:Date. ----------- Septic . ---------- REPAIR/ADDITION ADDITION Sanitation Permit ] (Prev.( Se tic Tank [Specify Requirements).___._.- ----""- t1a_. _J�y�c� Disposal Field[Specify Requirements}.-_ -± ------ '�17 - -------- ----------- =---r`~ ti ------- ----- ------- ------ -------------- r: - i.o . -------------------- ----- ----- � ; T.;_ _ . - ---------------- ---- � ----------------- ------------------- hereb ------ --------- -------------------- I [Draw existingand re- "" --""- --- ----- --- i �'uired�dition on reverse sid�`� i y certify that I have-prepared this application and that the 'work will,.be,,done, in accordant with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin L cal',H'L l4 i'District, Horse owner or licensed agents s- -�. signature certifies the following: r t I- to '"1 certify that in the performance of the.work for which this perrhif iso issued, 1 shall not employ any Pelson in such manner as betome subject to Workman's Compensation laws of_Califarma. p Signed. _ - ------- BY-1(-- ' ner ------ TitlerP - = r (If other than owner] _ -- ------------ ------ FOR,DEPARTMENT USE ONLY: , APPLICATION ACCEPTED-BY.-.___ __" DATE _ DIVISION OF LAND NUMBER:-- ...........----- - ------------- --'--- -- - "--- --- � �� - - DATE ----- ADDITIONAL COMMENTS. .-•.E . ;Q?04&- —.100'. - --------- s .-. f �, -...•. .i. •__• .._._... ... --- ............ ._.__..___..._ Final Inspection,bY: G: '.'-=--------------:----- G� T=-Date EH 13 24 - - SAN JOAQUIN LOCAL HEALTH DISTRICT F&s 2677 Rev. r/ori 3rn A,