78-1122 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Le �/� . _ __----•- - --------------- - ---------- (Complete in Triplicate) ,.. - '�,. ; 5^ _]- t --------------------------- This Permit Expires 1 Year From Date Issued= ----------------------- d r the for a pjr-rMit to nstfuct an Application is hereby made to the San Joaguir;Ln}alHealthr �esNot549 and a ist n oRuI 'an--&Regulations:Work herein de This application .is made,ia��comp�fiance,uvitfj,Gou y y �� _ ,y� � !� --- .CEN TRACT- - JOB ADDRESS/LOCATION----" --- .. (------- ---- E Phone-------------- ------- - - - ----------------------- ------- -'--------- ; Owner's Name..-- .: Cit -------------Zip-- ----- --------------- - Cl Address----1 � � # ,r- 1,71 hone._- -�{:� (J� License icense - P � ? Contractor s Name--:-- installation will serve: Residence Apartment House.❑ Commercial ❑ Trailer Court =------------- .. Mdtel ❑ Other--- ------------ " - ❑ Number of living units---_-- --------Number of bedrooms. Garb ge.-G�inder<f- -S--Lot•Size_.-.- ;-- Private P i ✓ _ -_-----=------------------------ d Water Supply: Public System and,name: ;---.--- - . � : Peat Sand Loam:❑ Clay Loam Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ ❑ y ;\ ; a Hardpan ❑ Adobe❑ s Fill Material_---- ----If yes, type s st et ced n reverse - �., ..�., -�.•- r {Plot plan, showing 'size of lot, location of system in rela'tanerm t eds'ifbpub icgewer is avabdble wi hon 200 feet}de.) t NEW INSTALLATION: (No septic tank"or seepage p p , ; : .....� --- -- Liquid Depth Size-- h-- --q � L PACKAGE TREATMENT [ ] SEPTIC TANK [ l: "- I r ' �?h +._ Material No. Compartments--.---- - -- Capacity- _-,- ` YPe ' .� d� ,y i _. �,� --- - , -------Pro Line Distance jo n'eare�s 1) _ n P ry - ,t ; Total Length l + No. of•Lines_ Length of each Iina ' ` LEACHING CINE: •[ ] tenal� - ---- - A` k= '°� = .'D' Box :! - �?YPe Filter Mat'rial-- - r.r -� F er,Ma f5 ,� i Property Line__._,f F ^ 1 Foundation_ -- /� " ` - P Y ♦- _ .a ,.Distance to nearest:Well ` j =-� = rt Rock Filled Yes N . Number �' -- - - Diameter. SEEPAGE PIT l (Depth } ._ .. -� ..._ t ` Water'Table�Dept F_�---- -.Rock Size:------ r • � F i / GaD - ` °foundation.=lam- " Prop. Line._�b---t------- Distarice�t8 nearest: ell- --f-------� ` "' - l , r ---- Date • - --- REPAIR Y A =------ ----------------------------------------- 41 f. - i /ADDIT1CNPrev:'-Sani�atiOn Permit - -------- ' .. : = . g -'='----- ------ {5 cifyRe virementsl = = = Se tc Tank i -------- - ------------------- -- -- -Disposal Field (Spec if-y,€Requ.irements) - - - ------------------ ------------------------------ ; `" (Draw existing and required addition on reverse sided } cation -and that the .work will be done in accordance with San Joaquin County I hereby certify that I have prepared this application Ordinances, State taws, and Rules and Regulations of the. San Joaquin Local Health District. Home owner or licensed.agenic signature certifies the fallowing: -person in such manner as r r = . i F "l certify that in fhTe-performance of fhe work for which this permit is issued, 1 shall not employ any t to become sul `to,.Workma j& n sX p sation laws of .Calif a." r �Ciwner ; Signed._. _ ------ r Title ------------------ ------------------- . {lf o er an.owher) i p E ;.._ ...�... ' - •?•� °� �- 'FOR�.DE ARTMENT USE-ONLY; APPLlCAT10N ACCEPTED BY-`-------- - ---- - - ---------------: DATE. L - ----------------------- DIVISION ---- -------------- - DATE.;: - DIVISION OF LAND NUMBER ------''-=.--------- --- - , ADDITIONAL COMMENTS----- -- ---- ---- ------ -- --- ------- - - - - - - -- ------ -- --- -----.------------ -------------------------- --- ----- _ -- - ------------------- ----- -- ' ----- ---- -------- .. _ •- our- :: _ : , --------- ---------- - --------- ----- --------- _ e:. - - - ---- --------- --------- _ - -- -- --- - -__ -- --- ----- - . - -- --- -- - ..Date ----- --- -- ------- Dater Inspection by:-=-= ` ----- .- -____._- ----- r&S 21677 REV,7/7 6 3M EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT