79-388 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: FOR OFFICE USE; APPLICATION FOR SANITATION PERMIT �� 3 �p Permit No.. .. ._......... .... (Complete in Triplicate) •----------------------------- ---- Date Issued '�.�`7.'--./- This Permit Expires l 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 ADDRESS/LOCATION.. O...... ../E�E7TLE/?'! LN...... D1r CENSUS TRACT----------------- Owner's Name_.._ �L�E... tIGK.OH_... Fl�le«/6.._S/`f�7>..... . ---.Phone ..... ---------- - -- - --- ! Address....... _ 7T. -C-ty'!!- -LA/.... ....... ......... City--- ....d : --------- ......... Zip-- ------ ------- --- nse Phone .y ...... Contractor's Name...... t Installation will serve: Residence ❑ Apartment House ❑ •Commeraal�Trailer Court_-❑�"" ,-'' ------------ ---------- Number of living units;......_._....--.Number of bedrooms....----- - Garbage Grinder.............Lot Size--------- -_........ . _ ......._,------------ ----.-. - Water Supply: Public System and name-- ------------------ -- Private ❑ Character of soil to a depth of 3 feet: Sand ❑ Silt ElClay ❑ Peat ❑ Sandy L.bam'❑ Clay Loam ❑ G• Hardpan ❑ AdobeX Fill Material . .._. _...If yes, type__--',_,...... i (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc, must be*11 placed on reverse side.) NEW INSTALLATION; (No septic tank or seepage pit permitted if public sewer is avoilable-within 200 feet,) ., L � 'E s� iquid �Depth.__.:.5.---- PACKAGE TREATMENT [ ] SEPTIC TANK S1ze .--- .3QC14 e.._R6CT....-_Ma#aria! -. O.(1C. No,'Gorr) artments Capacity yp - P, , .r . 1-� I _ �,' �/Q �`. to nearest:•Well�----------- --- Fou too i ;*.. ._.Prop Lirie 4`---_------------------ Distance LEACHING LINE [� No. of t'i e .-.------ - - �� Lin th of each line..._ TotaI'Le ngth . _- . S s t ff 'D' Sox_.✓....Type Filter Material._.!- .-.- Depth Filter Material'— ------ --- =' - " - -- - -. __...Pro ertLine..._ � - , P S� Diameter--------- - Foundation._ I P Y j Distance to nearest: Well---.-------f�- , _ - Rock•Filled Yep \ No.❑ SEEPAGE PIT [ Depth--o?._...... - - Number- ------- Water Table Depth.---fir' -- Rock Size---------- -------- ---------•------ ..._ , Distance to nearest: Well ------ ----- ----- - --------Foundation .:*.._...Prep' Line.:;.. ....*. - --- l f �a,l- � --�'--- REPAIR/ADDITION (Prev. Sanitation ermit#--- -- ------------- -- --- . -. -- --...gate ?__... Septic � Tank (Specify Requirements}.....`. . ----- . - ------------ ------------------ ---- �•f! x k "'• � Disposal Field (Specify Requirements)-.... ..------------ - E 1 �f __.._....__•______________ .. . _.. __ .F_ -X- _------ ` --r. IR (Draw eyisid ) ting and required addition on reverse se ., '.• f 1 hereby certify that I have prepared this application and that the work will be�one n cicordance�with- San Joaquin. County San Joaquin Local Hea�tf pistct; dome owner or licensed agents Ordinances, State Laws, and Rules and Regulations of the signature certifies the following: i''� `. "I certify that in the performance of the work for which this permit is issued, 1 shaft not•eenploy'any�person in such�rna_nner s to become subject to Work man"s—Compensafion law�ws o"'f` California." .� ' Signed---. Owner e # E,, (If other than owner) �, v FO DEPA TMENT USE NLY APPLICATION ACCEPTED BY------. .. I .... . rr �^ --......DATE _.* ,, _.S � ' �- :.*4y..._ DIVISION OF LAND NUMBER ------------- ........._---------__-------- ---=----- ---DATE... ADDITIONAL COMMENTS---------------- ---------- .................. --- ---------------------------- q _ /� `' - ----- ---- ------ ..------- ---- Final Inspelaction y:.__... f&5 21677 REV. n/7b 3M EN 13 24 a SAN JOAQUIN LOCAL HEALTH DISTRICT