77-197 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: , �{J APPLICATION FOR SANITATION PERMIT € ............. ............. Permit No. -7:7 6.Z 4 -- ----- 2 (Complete in Trlpilcatel� - � Date Issued . �.._.'7. ............................ ........ ........ v This Permit Expires 1 Year From Date Issued r Application is her®ty ado to the San Joaquin Local Health District for a permit to construct and install the work herein desy d. Thilicatio "a-le In compliance, with Count*-Qrdinance No 5Ao.nrd existing Rules and Regulations: r ✓~ - eJ 4U. / :-GENSUS TRACT .t✓ ... JOB ADDRESS/LOCAT ON �0 _ ,-•.� -. aK.:, * Owner's Name ..._ ... .�_i........ ... . ...mac....... _. ......................................................... Phone n Address .! ' ....- Contractor's Name _: _ ! '_. ------License � . Phone l Installation will serve: `± Residence [Apartment House 0 Commercial[]Troller Court 0 Ia Motel ❑Other --------------------------------•- Number of living units...... Number of bedrooms.....Garbage Grinder _� Lot Size ... .. .... ...... . ... •. _ l { � �. Water Supply: Public System and name ...--------••.............................................----............ -- -- -----------------Private-� Character of soil too depth,of 3 feet:. Sand E] Silt❑ Clay ❑ Peat❑ Sandy LoamA Clay Loam ❑ R1 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 TANK f ] � Size- --- ........................... Liquid. Depth .......................... F - Cq�apacity �pQ.-.... Type a#erlttl L�v, o. Compartments .. Distance to nearesrt: Well 1-11--71 ......... ___ ._._. ... Prop. Line LEACHING LINE +[ J No. of Lines :..: ..5__......._.. Length of each line--_--_- -©........_. Total Length .... .. 'D',Box ...... Type Filter Material ... ....bepth filter Material ...f.................................. I Distance to_nearest: We _._/� . 74-_..._ Foundation -- -.. Property tins . .... �S�JJ`. [ l , f Dept _._. ti -Dia ter ........:.......... -- Number ........_.......---.--_.._._ Rock Filled Yes ❑ No 0Water X4d3eDepth .--..---- _-• - ._.Rock ' ..............• ------•---- ...... Distance to nearest: Well .... ..............................foundation ...................... Prop. Line -•--------.----------. REPAIR/ADDITION{Prov. Sanitation<Permit# ---------=------------------------- Date .........-------------------------) �3t SepticTank (Specify Requirements# ------- ..........•---................•-.:......................_......_......................... ........................................... Disposal Field (Specify. Requirements) -------------------- ----------....... -------------------- ----------------- --- --------------------------------•--._.----------....-----------...--•----------•---- ---- -----. .... -- ----- i I . ' ------------------------------- •--------- -•-----------------•----- ------................_.._.,..-•------------------ ---.... (Draw existing and required addition on reverse side) -F hereby certify that I 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 licen- sed agents signature certifies the fallowing: "I certify that in the performance of the work for which this permit is Issued, I shall not employ any person In such manner as tobec s b) Mtorknum's Compens n law a Calilprn�"Signed . ---------------- - �- - Owner BY - = ....._... Title ---- r......_.... (if ther than owner) FOIAEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---------- -- DATE ------------•---- BUILpING PERMIT ISSUED ---- -. QATE __._ ..................... ...•`-- ADDITIONAL COMMENTS __.J tt,_?re� _. 1€� .. �J .� ... ! - � �Y! Vu '.................................•---------- ----------------• - --------------------......---------------------------------- ---------•.............. ..................................... fmo! •-------------- --------------- -- Inspection bY= - - ........Date . •----------- EH 13 2h 1-68 � SAN JOAQUIN LOCAL HEALTH DISTRICT 8�7h -33'f l t