79-31 - Laserfiche WebLink

Home Browse Search

a� FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No._79n-:7Y--- -- -- ----------------- This Permit Expires 1 Year From Date Issued Date Issued.-�_� - � Application is hereby made to the SanJoaquinLocal Health District for a permit to construct and install the work herein described. This application is made innccompliance with County Ordina e No. 549 and existing Rules and Regulations: , JOB ADDRESS/LOCATION .d- - r ------- --------.CE ----------- -- - Owner's Name--------- ---- ) u NS TRACT -+-_-. US R = --------- ----- Phone------ -------- ----- -- '---- Address --F ----------��----- City --------------- Contractor's ----- ------Cont.ractor's Name _ -- --t----- -2? License # �',.._�.Z -----Phone--------------- ----- i Installation will serve: Residence [ Apartment House.❑ 'Commercial 0 Trailer Court ❑ 6 [ Motel OtFier-------------- Number of living units:___. ------Number.of bedrooms_ --- Gdrbaga GrinderLot, I -----_ - --------------------- - Water Supply: Public System and name--------------------- -- • -----------------------------------------------Pr Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat 0 Spndy Loam Clay Loam ❑ Hardpan ,Adobe ❑ Fill Material---------.--If yes, type------------------------------- (Plot -------------- - - --(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,) PACKAGE TREATMENT •.i •) . SEPTIC TANK [;l Size___________________________ _ --------------------------Liquid Depth.--- -------- -. r Capacity,- ;` = = TYPe- Material --__--_---------No. Compartments-- ------------ ------ -------- Distance'to nearest: Well-------------------------------------=- Foundation-- =.--- ----------- Line------------------_____ LEACHING LINE; [ .J No..of Lines_, _�____._-.-- i -:--- Length of each line,----------------------- -Total Length._..----------------- - D' Box---------_--Type Filter Material--------------------Depth Filter Material---------------------------------- .-Distance to -------------------------------Distance.to nearest: Well-'------------- ------ ----Foundation.--:-----.-------""�'-Property Line-==_.-.-_ ---° ---. ;. i SEEPAGE PIT -' I l Depth----------------Diameter-----------.---------Number---:-----------.--------------k Rock Filled 'Yes [] - No ❑ Water Table;Depth-----------------------------------------------------------Rock Size' = r Distance'fo nearest:"Wal!_-.-__._'----- ----- --- Foundn: atio ..: ---------------------' -Prop. Line_.- -- REPAIR/ADDITION (Prev, Sanitation Permit#-_-_............... Date -- -------- ' Septic Tank (Specify Requirements)__..- +................ : = - R ............................ Disposal Field (Specify Requirements):._ _. _-_ �— `: --" ---c.---� - -- "---�. --- "---- -- -"�---- -- ----� ---------------- -- =�. --- ---------------------------------------------------------=----------- (Draw existing and required addition-on reverse side) i I 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 Regulation_s of the San Joaquin Local Health District, Home owner or licensed agents signature certifies the following: j "E certifythat in the -• •L - performance of the work for which this permit is'issued, I shall not employ any person in such manner to become subject to Workman's m as ensation laws .of .California." _ Signed--------' ------------- --------- 'Owner ' _-- i __ . . ------------ By- n (If other than owner) , .. Title FOR-DETARTMENT USE ONLY - APPLICATION ACCEPTED-BY.___% --- _ DIVISION OF LAND NUMBER:.._-------_--_-- - ------ -- ---------DATE. w " 7 DATE---- ADDITIONAL COMMENTS____________________ _ ------------------- --------------------------------------- ---------------------------------=---------------------- --------------------------------- -----------------------------------------------------:-t ---- ------------------ - - -------'-- Final•!ns action•b � -- - -""" --- -- - ---------- -- -"-- P Y - ---- --- ----- =----- - �..�. �.__. _� _ :.. Date ------------------ �. EH 13 24 SA JOAQUIN LOCAL HEALTH DISTRICT F&s 21677 REV. 7/76 3M