78-510 - Laserfiche WebLink

Home Browse Search

I FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit %a - ----------------------------------------------- (Complete in Triplicate) ,r' - ----------------------------------------- -- Date Issued----------r-------- --------------- ------------ --------------------------------.-- This Permit Expires ] 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: JOB 'r r• � a �� Q t ADDRESS/LOCATION-,---- ---------------------- ------------------------------- f4_ CENSUS TRACT ' Owner's Name.------fest-�r.f-- / �� ------------------ -------------------------- _ne�--- -- ----------- , Address- - E _/ - --- -----.---- City -c�La zip �- Contractor's, Name___---. ____-License # _ � al� c ----Phone r I Installation will serve: Residence Apartment. E]House CommeF]rcial Trailer Court- Mote ❑ ❑ - - Number of living units:--__{__.____.___Nu.mber of bedrooms._- Garbe e Grinde ------------ Size------- y: Public System and name------------------- - ____._-_ ------------------------- --Private Water Suppi 0 r Character of soil to a depth of 3 feet: Sand E) Silt E] Clay ❑ ' Peat❑ Sandy Loam El Clay LoonI Hardpan ❑ Adobe F-1Fill Material__ y__.-____.If es, type------------ - ------------- j r (Plot plan, showing size of lot, I cation of system inrelation & wells, buildings, etc, must be placed on reverse side.) "' N ' NEW INSTALLATION: (No septic tank or a pagelpiIpermitted if public sewer is available within 200 feet,) Q` E th- ----------- PACKAGE TREATMENT SEPTIC TANK Si�e------ � -=- ---=-- �`-"---------- -------------Liquid De Ca aci T e =: " =':.Mateo ial-:" = ._._No. hfh line _ Compartments -------=--- -------------- ...Prop, ---------- .Prop Line ----- YI ----- Distance-to nearest. Well ._- --_ .-.-- - ---- Foundation ------------- Total Length--------------- LEACHINGLINE, .. -_ D' .� Box-._-- --- _Type 'Filter Material --- - -k-----Depth.F;ilter_M rial -- r--- ---- ------ -- -- -- i..... ¢ ". Property Line 3 ,Distance to nearest:;Well_ � --------------------Foundation-- -"- P .tY - � :mss�"'Y f• � � �- I _____ ____ ____Diameter: .... _.__ Number. -- ----------------- Rock Filled Yes;❑ No ❑ SEEPAGE PIT [ ] Depth. '- 3 Water Table Depth --------- --------------------- _= -.Rock Size , ! '' ` l - L,'�... .,.,...... .: . —w --------------- u dation _...Prop. Line - - ------------ �� ( Distance.to nearest:Well __ __ A+T -Foy -- t r REPAIR/ADDIYION (Prev. Sanitation Permit#' ------------------------------ ------Date-._,- ___._._ -._- - ��-- ---- -1 f R a , l Septic Tank,(Specify Requirements)-------------- ',R �`�. - �- y---- ---- �' `= ----- 77 rF + Dispose i d {Specify Requir men - 1 - -,-_ r.. :- - - +?C-- 1 ---------- ------------------- - t = _= - ------------------- ------------------------------------ -- - ------ -------- ----- -------------------- ----- � �� . _ ,._ (Draw existing and requd't> clition o revers ide] � • i application and that the work willi'6e done in accordance with San Joaquin County i I hereby certify that 1 have prepared this pp E. Ordinances,1 State Laws' and Rules and Re_gulaiions of the`4Sari Joaquin'Local Health District. ,Home owner or licensed agents signature certifies the Following: "I certify thb t R--the performance of'the-work for' which this permitis issued, •1 'sh'ali not employ dny person in sucjFi manner as to become.:sub;ect. -to. Workman's Compensation, laws of California ':' y c r # ' � I lar k ------------ 'OwenexSigned . - ------------------ ..:-------T _______________;_'_ _ -------------------------- --- _ - r-__gY [:-> -- r-__ C— f ofher than owner) ] FOR DEPARTMENT USE ONLY ' . "- :.--.-- _- ----------------- lo: ------- _\1111 biid!ir, yY .�' E APPLICATION ACC-EP7EDBY - _ -- --.. "' DATE .--- ---DIVISION OF LAND NUMBER. -------------- ------------ -k . ADDITIONAL COMMENTS-- ------ ------- -------------------- ------------------------- 1 ------------------------ ---------------------------------------------- ------------------------------------ ----------------------------------------------- ________ __ _ ____ ___-__.________-_______..____ -----.-_-_--------------------------------- - _-.-_.---_ _____.----_--___- _--_--_----__ Z _ _'. _________________ __ ____ ___ _______________________________________________________ _.____-________ ..___..-------------------------------------- f Final Inspection-b '� &5 21677 REV. 7/76 3M EH 13 24 SAN JOAQ LOCAL HEALTH DISTRICT