77-974 - Laserfiche WebLink

Home Browse Search

FOR OFF1C U�E` FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ---------------------- -�4- ------ - Permit No._72._ �� (Complete in Triplicate) ----------------------------------------- ------------- -- �"'�. Dade Issued...._. ,----------_-----------------=---.____-------------- 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. 549 and existing Rules and Regulations: s ----- ------.CENSUS TRACT-- - ---------------------------- JOB ADDRESS/LOCATION--_-. - _ _ - Phone --Y777,,77 � 7� -------------- ------------------------------------------ Owner's Name Address _ = City --- -----------------Zip-------- ------------ -------- --------�,- � Contractor's Name--,----- G��` "`4 ------ License # = Phone Installation will serve: Residence ❑ Apartment House.❑ Commercial ❑ Trailer Court ❑ f Motel ❑. . Other-=----------=--------------- --------- ---------- ------ Number of living units:___.- -- t -- �r of.bedrooms--_ _ _.Garbage Grinder------------Lot Size------ ----- -------------------- AU Water Supply. Publ-ic'Systeffa = --------- -------------------------- -- ---------- ------------------Private Character of soil to a depth of 3 feet: Sand ❑ Silt ❑ Clayw :; Peat ❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe - Fill Nlateria;l__ _._�N_If yes, type-------------------------------- r (Plot plan, showing size of lot, location of system in relation to wells,ibuildings, etc. must be placed on r-6ve* e`side.) NEW INSTALLATION: '(No"septic tank'or seepage 'pit permitted ifIpublic sewer is available within 200 feet, PACKAGE TREATMENT [ ] SEPTIC TANK- P] size----------- -- -------------------------------------------Li Liquid Depth--------.---------------- q Capacity --- -- -----=------ TYPe ---- -------------Math'rial--='------------------:_=_No. Compartments - 4 ► Distance to nearest: Well-------------------- ---- ----------------Foundation.------------ -- -_-----Prop. Line---------------------------. i E' No. of Lines ..�� Length' e` '-- - ---- - .Total Length. LEACHING LWE [ ]„ NDo.�of Lines,=.-�---_e Fllter Material of each lipepth Filter Matencil-:,�t`__--------------__________--'--------- -------------------- Distance to nearest: Well i_ � ---- Foundation._____.___ ___- - !__.Property Line----- SEEPAGE PIT [ 1 Depth-.__ _. ----- . Diameter _ ._`- -^Number --_ ______ _.. - -- Rock Filled Yes ❑ No❑\7 - - Rock Size ----------- ;Wa#er Tabl ----------------- Line ------------- Line -----------------------D stahce_to_nearest. Welll------------------- - ,Foundation.------_-REPAIR/ADDITION {Prey:Sanitation Permit#------'-------------------------------� " " =_--- Date -- ------ ----------------- -- --------------- -- --- --- - i Septic Tank (Specify Requirements)--- ---------- - : Disposal Field(Specify Requirements)------------- -------------- ---- ------------------------------------------ ' ---------------------------------------------- -------. _ + rl � ----- ---------------- -------------- ---------- --- ------------------------- -------------- ---------- ------------ -------- --------I------------------------------ k {Draw existing-and required addition on reverse de)_:-_ `" ? I hereby certify that I have prepared this application and that theworkwill be done-in accordance with Son Joaquin County Ordinances, State Laws; and Rules and Regulafions of the: San Joaquin Local Health District, Home owner or licensed agents signature certifies the:following:,_, { F "I certify that in the performance of',the work for which this permit islissued,)l shall -not employ any person in'such manner as Workman's Compensation to become subject to laws of California." Signed------------- f Owner --- ' ----- Olwe C..y-- _.:r r ------------- f other than.owner) FOR DEPARTMENT-USE ONLY- ` I APPLICATION ACCEPTED BY----- t rJ1 - '------------- DATE. ' DIVISIONOF LAND NUMBER:---------- ---- --------------------- ------------------ -- -----------------DATE--------- -------.--------------------------------- ----ADDITIONAL COMMENTS--- --------------- ----------------------- --------------- r' P---=----- ----s-- - ------------ -----'''>------------------------------------------------------------------------------------------ -� == it L,A 1 �,iz' N � ") ------------------------------------- -------------- -------------------- ------------------------- -------------------- .. -- -------------------------------- ---- ---------------------------------- --------------------------- -------------------------------- --------- ------------- - -- Inspection b ��----------- ----'-------'------------------------------------------------------- = Date 1677 REV. 7/76 3M P Y EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT