79-484 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: C0CEL, APPLICATION FOR SANITATION PERMIT ---------- ------------------------- f (Complete in Triplieate) Permit No: ! ------------------------------- -------------- Date Issued f- ----------------------------- This Permit Expires ires 1 Year From Date Issued 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 complian with County Ordinance o. 549 and existing Rules and Regulations: . Q I � J013 ADDRESS/LOCATION ._-.�1�'�'-'-�-- --�-E-`3�---�---� --o�,�-- --------°----------:----CENSUS TRACT --------------- ----------- -------------- ---Phone; e ® 4 Owner's Name l�� -�--------'�' -- -�--'��-�--V-� ---- : ----=-•-------------- Address --- City -AV_99 4460----------------------- Contractor's Name _# —V�' --------------------------------License # ��- Phone1p– Installation will serve: (ResidenceApartment House❑ Commercial ❑Trailer Court ;❑ Motel Other Number of living units:--/--- - Number-of bedrooms Garbage Grinder _� Lot Size -____________________________-_________... r _ Water Supply: Public System and name ------------------------------------"----- --------------------------------------------------------------------Private Character of soil to a depth of 3 feet Sand'❑Silt❑ ;Clay ❑ Peat❑ Sandy Loam Clay Loam '[] Character IHardpan ❑ 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.) NEW INSTALLATION: (No septic tank or seepage pit permitted if publicseweris available within 200 feet,) f� PACKAGE TREATMENT [ I SEPTI TANK f ] Size------------- ---- Xl�------------------ Liquid Depth ___9/r- --- ----0'. Capacity --- --- Type ,�Rr. t��r Materiald"k No. Compartments ---�_._.____.__. Distance to nearest: Well ---1-�--`--------- ------Foundation _ d---------_---_ Prop. Line __ -------- LEACHING LINE [ ] No. of Lines ------4;1-'----------- Length of each line------._ __________ Total Length ___ --------- D' Box --- • ry G ' �____ Type Filter Material -1�__________Depth Filter Material ____/__�___-____.____------------------ 6 Distance to nearest: Well ________________________ Foundation ------------------------ Property Line ______-_______-..:.--- SEEPAGE PIT f ] Depth I------------------- Diameter ---------------- Number ------ --------------------- Rock Filled Yes '❑ No I❑ WaterTable Depth ------------------------------------------------Rock Size -------------------------------- Distance ------------ -- - ------------ Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ---------------------- RE AIR/ADDlTION --------------.--.--- REPAIR/ADDITION(Prey. Sanitation Permit# ---------------------------- --------------- Date ---------------------- -----) SepticTank (Specify Requirements) -------------------- - ------------ ------------------------------------------------------------------------------------------------------ i Disposal Field (Specify Requirements) ------------------------------------------------------------------------------------------------------------- ----------- ----------- ---------------------------- -------------- ---------------------------------------------------------------------------------------------------------------------------------------------- ------ F (Draw existing and required addition on reverse side) 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 Regulations of the. San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner as to become subject to rkm6's Compensation laws of California." Signed '"`"`-' �I/Le ( Gr-��- -------------- Owner By --------------------------------- - --------------------------- Title -------------- --- ------------------ (If other than owner) ` FO DEPARTMENT U ONLY. APPLICATION ACCEPTED BY - ¢^ '------ -- DATE "' � BUILDING PERMIT ISSUED ------ ----- ---- --------------------- ----- --------------- DATE ADDITIONALCOMMENTS ----------------- -------------------- ----------------------------------- ------------------------------------------------ ------------- ------------- F ----------------------------------------------------------------------- -- ------------- - ------------------------------------------------- ----- FinalInspection by: --------------------------------------- --------------------------- ------------------------------------------------Date --- ---- ------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M