78-251 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ,f ILICATION FOR SANITATION PERMIT FOR OFFICE USE: ------------------------------- ------------------------ f [Complete in Triplicate) ,p' �S"� ---------- - ---- ermit No.- This Permit Expires 1 Year From Date Issued --------------------- Date Issued.__ Application is hereby made to the San Joaquin Local Health District for a permit to c ;ru This application is made in compliance with County Ordinance No. 549 and exa isting 1 work herein described. r� JO !DRESS'LOCATI Q w -- Ow `=----------- US TRACT..-----: - Address---- _; h -- -- -City P one Z .: s - - Contractor's Name -------- � ., �n - Zip- I - ---= -- --- --- Installation will sere: --------------Phone_��t?- _ a �. Residence A artment House.❑ Commercial 0" rgiier:'Court ❑ )- M i .;. .. .K otel.❑ Other_---Number -- ¢,... ------ - - -- Water S of,livmg units___ _ ___________Number of bedrooms_3:�'�Garbage Grinder-__._____��0 5ize__ f ` upply. Public System and•name____'.__- - ---- --- [ Character of soil to a depth of 3 feet: Sand Silt Cja - private ❑ Q ❑ Y:.❑ �eat❑ Sandy Loam ❑ Clay Loam Hard"�an _ p ❑ � Adobees, ` Y type ------ [Plot plan, showing size of lot, location of system in relation to,w'gIls, buildings, etc. must be placed on reverse side.} NEW INSTALLATION: "- -, _ ,� i,� , j : [No�^septic tank ,or seepage pi}permi.tzd_if public sewer is availablew�th`in 200 feet,} 1! PACKAGE TREATMENT,- j SEPTIC TANK P"c f r ! "s _ l . . ., Size--- --_ �r r � 9P , - /� _ - -------------------- Liquid Depth. •`' -'> �-� -� Ca acct � ' - ---- ------ P Y- �o`'T a Materia _'. . - No LEACHING to nearest:.Well:=.-----_'---------- . _ Com rtments-=--------------------- Distance ----------- Founclation��' NG LI t Pro ine.__ -� •. No. Lines-------- -------.Length of eac line.----- d- t __Totgl-L n'gth --- _ _C - t ._ - Bow- Type Filter Material_.. - ---De th Filter Material ' P ,R .--- R � �•..t Distance to nearest;Well ----_ � - �Q' F� - ---.-._ --Foundation---� � r _-----Property Line____- --- SEEPAGE PIT '7 ' " "r f l Depth__ �- Diameter-. Ej� _ s _ t Number 1 F Y N ..-,.¢ r. Water Table Depth `.. . `' f ., ock, led - ----------------------------- -..R-oc e�� ► R es k Siz ` ' l -.. °---------- a 0 ' Distance'to nearest: Well__.___'______: ¢ f- �� Foundation_E:__ � 't- REPAIR/AD [Prev. Sanitation Permit#_. '____ ___ `ice'`` Prop. Line--- - - = f ]. )--------.Date _ _ _ Septic Tank{Specify Requirements]__ _______________ ___ ` _ ______ _______ ' I IA-__ _ _____ -__r--------------------------------- ------ _.__ __ _ 4 Disposal Field-{Specify y e uir ments)—_------_-`- - .- ass'' V� -fi r ` --- ----------- ----- ----------- -- - _ - --- ' -o ---------------------- [Draw existing and required a'dditioriyon reverse side] I hereby certify that I have prepared this application pnd that the }work w�I�.�be�'dnne� in accordance with San Joaquin County` Ordinances,. State Laws, and Rules:and!Regula:tions of' the San Joaqurn ILocal Health District; Nome owner or licensed agents signature certifies the following: }} - "I certify that in the '`l performance of the:Work-for which-ibis permit is issued I-shall not employ an to become subject to Workman's Com pensati I wa s- 'Iifotrsia.". . p y� Y persen1in suchanner as i Signed--.---- _OWne�r [If t Title } other than`owner} : a.- r o, 9 f T FOR DEPARTMENT USE ONLY- 1 APPLICATION ACCEPTED -- DIVISION OF ..-__-- J ------------------- ---\ re DA"TLAND-NUMBER. ..-_ ------------ ---------ADDITIONAL OMMENT - - ' t - DA �aJ ----------- E` ---------- -- - D� -0 t ---------- I/ - k t'3' j_--- --- --- �, ► Final Inspection by: .. -------------- ---------------------- -- ------------- — -- —� y- ----------------- ------Date = EH 13 24 \ -- -------- --- --------------- SAN JOAQUIN-LOCAL HEALTH DISTRICT Fes lir 7/76 3M r ti.,ti 4 - � 5�--"'+w_a•�..�..a_�..:. y_--' ��,1. gam... . .. 1