78-960 - Laserfiche WebLink

Home Browse Search

i FOR OFFICE USE: , ' FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT O {� _i --------- ; No.73 (Complete in Triplicate) P/ 17et--- ----------------- - .-• � Date Issued.lp_-:--V_:,:�� --------------------------------------------------------- This Permit Expires 1 Year From Date�lssued i 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: ------ - ,---.CENSUS TRAT�_� JOB ADDRESS/LO TION-... 5 ::: ' Owner's Name. " ---------- ------Pho ' - --- -- �. . � �- to � � �� zip --�S Address ----------- ---�-•------,-- �--- - ------------_�� - _ -------------- ----city - ---- ----- ---- --...- - ------ ---- -------------- --- - - ; Contractor's r f --- License .:��/ __Phone cj��"� Name- _ � ' --------- Installationywill..serve: Residence ®. Apartment House.0 Commercial ❑Trailer Court ❑ Motel ❑ Other---- ' --------------------------------} y / 3 %:' ' v ► Number of living units------___:_----Number of bedrooms-------_._-Garbage Grinder___- Lot,Size_.._____ ----- ------------------ Water Supply: Public System and name r . ,pr•v. afie �— -. - Character of soil to a depth of 3 feet: ' Sand ❑ Sdt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ s 4 Hardpan ❑ Adobe (jj� Fill Material_--- yes, type--------------------------___._ k (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,) " X k l o �'z / 5"S. PACKAGE TREATMENT ( ] ' 5ize___.C!__; -- _ ----Liqui SEPTIC TANK Depth.-_-----------------------\j ' fi Caacit ll//__ O --------------: P Y./-&a";-- Type Material__.--:-� No. Compartments ---- --- ` Distance to nearest: Well-------- c -------------------------Foundation.,-'-----------._.Prop. Line___.r ---------.- - t ;ff r LEACHING LINE ::('�j'No, of Lines-= _ -r-_-_'--------Lepgth of-each-line."``,�S-�___-_�-_4--.Tota! Length ----1-q! ------ i " w { X -L D' Box./y__-Type Filter Material --------- --------- Filter Material:-----___ -_-__-__ ...- �Distance to nearest: Well_----- d-- '-------Foundation__s�0----.-_-- -----Property Lin __ _ _SEEPAGE PIT [t.]� De th __- _-Diameter-.:-__ _- Number ___Z �" "telp `� -- Rock Filled Yes 8�Na ❑ Water Table'Depth----. ��- �_--_�7 --' -- --.Rack Size.` -- r ° „ r_ i �/ • Distance to nearest: Well /'7 _ _� �._r_- Prop-L-'ine- f Foundation.___•: s___:. WDate--------------------------------------r. ------1 L" - REPAIR/ADDITION (Prev.' Sanitation Permit#............. '�''� - fE-� . , --=--------------------- ----- -" • ' i " --- Septic Tank (Specify Requirements)----------------------- ] ---------- -- Disposal Field (Specify Requirements)------- --- -----------------------------•-----� ----------•------•------------------ ---------- *-_--- -- 1 _-"-- -----------------l_(_____.-----__---5-...--- --••--------.•[[------_____________--------------- __-�_____ ----_..-______ _---.--.-._-"-- r y -- I {Draw existing and required addition on reverse side] i �� hereby certify that I have.prepcired this application)and-that-th-e-work-will"lie done in accordance with.Son- Joaquin-County Ordinances,-State Laws, and(Rules and Regulations�of the San Joaquin Local Health District, Home owner or licensed-agents signature certifies the following:-, "I certify that in the performance of"the work Jor which this permit is issued, I shall-not employ any person in such,manner-as to become subject Workm s_ Compensation laws of California." u Signed - - ' =--------- ------=---_--Owner - - -. SY — Tltle-- W�[G--. k (If other than owner) , I FORPEPARTPAENT USE ONLY APPLICATION ACCEPTED BY---- - .. .j -rr-------- ------DATE.------ 3f 7------------------- DIVISION ------------- ---DIVISION OF LAND NUMBER'- � = ---------------- DATE----------------------------- - ---------------- ADDITIONAL COMMENTS---'` --�--� -- ----- -------EZZ ------- - -------------------------------------------------------- - --- - ---------------------------------------------------------------------------------------- ----- ------ ' --- - --------------- - -------------- -------------------------------------------------------------------------------------------- --------------- ------------- Final Inspection ---Date.---�� ---- - 7 --------------------- EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT Fes 21677(@ 17b 3M