77-215 - Laserfiche WebLink

Home Browse Search

_ FFOR OFFICE USE: OR OFFICE USE: APPLICATION SANITATION PERMIT -`----------------------------- ----------------------- .J_' Permit No.--- -7-.:�2/ a -(Complete in.Triplicate) ~ Date Issued_.--------1----------7 7 •_______________________________________________________ This Permit Expires.1 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. 54 and existing Rules and Regulations: JOB ADDRESS/LO ION 011— ----------------------- ---CENSUS TRACT --- ----- ------------------ Owner's Name...-- ------ - ---'- ------- --------^- ------------------------------- -------------------- ---- Phone---------- - ------------ Address------ City ] Zi -- ' - _ Contractor's Name________- License #a.z .S._ 9 -Phone__-- ---- -- ------------- _ Installation will serve: Residence;g Apartment House.❑ Commercial ❑ Trailer Court Motel ❑ Other----------------------- ---- ---- - ---------- t- Number of living units:_____ ._____Number of bedrooms_----Garbage Grinder------------Lot Size__.J ___._t..__ ___,.________---- Water Supply: Public System and name-------- ---- -------------------------------------------------------------------- -----------------`---------------------------Private Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam ❑ v Hardpan Adobe ❑ Fill Material------------lf yes, type____________________.___.___,__- (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 rsewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK Size __0/ -��-/-- - -- _____________ Liquid Depth _' .___________.___ -------- Capacity-/,;J60 ___TypeFAe4,_�__._Material_i.�Q�^-'__-__--No. Compartments.__.__.__._O ____ --- Distance to nearest: Well -- ---------------- Foundation.__�d__I___r_____._Prop. Line__.-_. LEACHING LINE No. of Lines----� __________________Length of each line,._y�__-`�--¢__yQ.Total Len�th -______/ C1 ��aa nn i 'D' Box_..�__.._Type Filter Material_c�t.i' 0( '*/f�.Depth Filter Material----- ____ ____________ r f err Distance to nearest: Wall___- �)U Foundation.___-�? ________.{_____-Property Line__ r rr , SEEPAGE PIT Depfih._ S.____Diameter_.__3 Number.__._-___________r_r__•_ fr Rock Filled Yes No Water Table De th--_------- _-6r)-------------------------------- Rock Size-_ 3 Distance to nearest: Well__.., __________------___--____Foundation ----------Prop. Line--_- --_ .___ REPAIR/ADDITION (Prev. Sanitation'Permit#----- ---- ----------------------------------------Date------"________________.__..___-_-_-__.._-- _) Septic Tank (Specify Requirements)--------------------------- ---------------- ------------ r_ a- Disposal Field (Specify Requirements)---------------------- --------------------------------------------------------------------------------- --------------------- j - • --------------------------------------------------------------------- ----------------------------------------- ------------------------------------------------ -------------- i r 1 j• (Draw existing and required addition on reverse side) 1 hereby certify that I have prepared this application and that the work will be done in accordance with San 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 AbaQn the performance of the work for which this permit is issued, I shall not employ any person in such manner as to beco a iect to Wor an'som ensation laws of California." 1Z Signed t + = -_----------------Owner BY--------------------------------- --- - -- -- ----- --------------------------------Title.---- -- z(If other than o er) . FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- - ------------------------------- -------------------------------DATE ,1- /----7,7--------------------- DIVISION OF LAND NUMBER---------------------------- -------------DATE------------- ----- ADDITIONALCOMMENTS -----------------t-------------------------- ------- --------------------------------------- ------------------------ --------------------- ---------------- ------------------------------------------------------------------------------------------------------- --------------------------------------------------- --------------- ------------------------------------------- --------- ---------------------------------------------- --------------- ---- ----- ----------------------------------------------------------------------------------------------------------- -------------------------------- ---------------------- ------------ ---------------------------------------------------------------9---- --- Final Inspection by:._. 2 ' --------- ---------- --------------Date---3- ` - -- 2 ------------------ E++ 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F85 21677 REV. 7/76 3M