77-909 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT l Permit No.__--,-' ----------------------------------------------------- (Complete in Triplicate) p-- ---------------------- ----------- ---------- --- - r Date Issued_ �_._ --' 7,7 --------------------------- -_ This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit7to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION---/ S --- ------ f - .CENSUS TRACT Owner's Name `% t -----Phone --- - -;----- = - 3 - rt hon `� -. c F Address �.� l•- ---------------------- ----- ' City : �1P -� / License #-ef --�Y7---Phone �� d7.._... Contractor's Name.---- ----- y:. --- e Nf Apartment House ❑ Commercial ❑ Trailer Court ❑ Installation well, serve: Resident otel ❑ Other----------------------------------------------------------------------- s Number of living units_________________Number of bedrooms-----�--Garbage Grinder------------Lot Size_...-- -- ___-.---- w --------------- ----- -----------------=-- -- -------- --------- ,--:--------------- Water Supply: Public System and name.__ Private Character of soil to a depth of 3 feet: Sand ❑Silt ❑ Clay ❑ ' Peat❑ Sandy Loam Clay Loam ,,Hardpan ❑ Adobe ❑ Fill Material._.__ ._____If yes, type___ _ '________________ (Plot plan, showing size of lot, location of system in relation to`wells, buildings, etc.must be placed on reverse side.) INSTALLATION:NEW (No P } re e Pit'pa 3Z`tted F available within 200 feet,u lic sew is _ TZ/-------------- PACKAGE -----PACKAGE_. .TREATMENT T Ca R acSi;Et yP.TlICb.TANK =Ty.Pe_=r �:.Miaterial__C�/u-11---'---N C.o`m partments.-------- ------- -------- . . .... _ _____ oion..: O---- ---------Prop. Line.__._ ____-_Distan\co ne�arest: Well �Fun LEACHING LINE No. of Lines:_= '_ -------------Length f ch line_.___ _.-_--.. ---- - .. Total Length =- ----------------- c D' Box --Type Filter Material.. ._._ _,_____Depth Filter Material __..__ _------------------------------------------- D -_____ _ Distance to nearest: Well)_' __.__---25V -t -_ --_Foundation-_-..--�d____�-____--Property Line--_; ____________.__-__.___..r i - 4. .a, r _ ` I _.� `mss,; � . �. , SEEPAGE PIT �( Depth--/D ;.,r. .ti�r i ❑N ' yNumber___ ___.__________ _ ___ __ Rock Filled Yes No Water Table Depth----------t,-- ----------- '------- Rock Size----/�?•` =/ I-- i Distance to nearest: Well-..-- ------------------ ---------Fundation.----��-_---(-- P,top. Line—S-------------------- REPAIR/ADDITION (Prey}Sarippitation% .Permit#-- ------------------f_._ ` - . _.--:---.-- -----Date.-----------} -------------- -_- ) Septic Tank (Specif R quirer>ientsj r__� z''_ _ ._ may' -- -- j� � �'� -- - bisposal Field (Specify Requirements)--------------- ---- ----='-41 ------=------- ------------------ ----- ----------•--------------- ------------ ------------. ----- ---- -- ---------- ----------------------------------------------- - --------- r - - - ------------------------ ------------------- --- { ------------------------------------------------------------addition �praw existingand-required ,hereby certify that I have prepcired this application and`that the work``won reverse in ill be done in accordance with 'San- Joaquin County Ordinances, State '.Laws, and Rules and Regulations of ilii San Joaquin Local Health District, Home owner or licensed agents signature certifies the following: k "I certify that in the performance of-the work f6-'which-this permit-is-issued,_I-shall not employ any person in such manner as to become subject to Workinan's Compensation' laws of,',,California:" Signed f? -- i . . . i Owner _ --1Title -- _;t' 8'- - i l ---------4:;J-- BY-------- (If ofer than'dwner) a --'-- > ""F PARTMENT USE ONLY— APPLICATION NLYAPPLICATION ACCEPTED BY ----- `------- DATE. I'-f—Ji-- --- --- --- - -- ---- DIVISIONOF LAND NUMBER- -.-----------------------:------ -- ----------------------------------------- -----------------DATE - ----------------7- COMMENTS------------------ ------ - -------------- ------------------------------------------------------------- --- ------------------- -- --- -.-----•---------- ------- - ----------------------------------------------------------- -------------------------------------------------------------------------------•----------------------------- ----------------------------- -- ----- - ------------------- -- -------•------------------------------------------ -------------------------------------- ----- 1--------.----- ------ Final Inspection.b ff ------------------Date--_�. -"�- -----•-----.-- ------ EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&5 21677 REV. 7/76 3M