78-915 - Laserfiche WebLink

Home Browse Search

w .: �.. . ` .. } .. LDt R OFFICL FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT No.� '915. --- (Complete in Triplicate) issued-IO.._:J�=-? ...---.---- . ---------- This Permit Expires 1 Year From Date Issued Application is hereby made ta.the San Joaquin Local Health District for a permit to construct and install she work herein described. This application r madead to.the Sac' with County Ordinance No. 549 and existing Rules and Regulatians: - CENSUS TRACT-- ••----- Y ------- --- JOB ADDRESS/LO AT ON_......_.._A40 Phone_._.... -- �,, _._ }. .. �._. Owner's Name---- 1 Cit ---- Zi - p � - i y_ ---------- Phone._.= Address---- ----- -- � :.� i � � License #.._ -•-- Contractor's Name.-_.._ - --- a Commercial ❑ Trailer Court [IResidence Apartment House ❑ v installation will serve: Motel ❑ Other---- --- ------- ---- -- --------------------- u _..._Lot Size_.._..--...,�- �.�•-----,-----=-�-...------ k private al- A -.-. V Number of living units:._....._....___Number of bedrooms_.. _. ..-Garbage Grinder_ � --------------- Number Water Supply: Public System and name-_ peat Q: , Sandy Loam ❑ Clay Loam El Character of soil to a depth of 3 feet: Sand El_1i Clay.❑. : Hardpan E] Adobe V. Fill Material../!f - if yes, type---- -------------------- -- . (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) k NEW INSTALLATION: (No septic ;tank or seepage pit permitted if public sewer is available within 200 feet,) --- ......Liquid Dept � -... { _i (` TANK S' e.....-. . „ PACKAGE TREATMENT [_ � --- - ¢.�*]o. compartments.___.--..•--:-..---.--- ..--....� ciEPT1lC� Tyne =� �Q- -.Mater+al Capacity Pro Line...-- r istance to nearest: Well... -� Foundation...._. ..� - p C� I ......:Length of each-line.- . Total Length .. .�- LEACHlNG LINE [ ] No. of-Lines. ."-== • _ _ De th Filter.Materlal.._- - -----�- - 'D' Box. .. 5 Type Filter Maternal.. P - r Line.....5.-----� ---- 0 -- Foundation------1..D-- P y a ❑ Distant tornea est: Weil..-.- it ` Rock Filled Yes I Diameter - -. _ Number..-.--- ------ �J SEEPAGE PIT Depth._. i Rock Size-_Rock Sil .......... ... . ..L.. Water Table Depth._:----------I...... Pro Line.--- -�-�- �--- - }1 U._�-- l ----------- -- -Foundation=- : a - p Distance to nearest: Well ---- q ----) + II -----------Date-------• .._.. .--- ------:•---- REPAfR/Ai]DITION (Prev, Sanitation Permit ----- --- -- ---- ---- ------ _• ----------------------- :....._ Septic Tank (Specify Requirementsl�-�-- -- ----- ------ - . --- -- ....... .... Disposal Field (Specify Requirements}.............. . __------....-: ' -•---- -----•. . . - 1 !..........._ r� ------------•------ - ------------- -------------------- � quin Count �� (Draw existing and required addition an reverse s+ e I herebycertify that I have prepared this application and that the worak u i lLD aldone Distin rict. Home owneance with d or signature ages Ordinances, State Laws, and' Rues and Regulations of the San Joaquin signature certifies the following: to any person in such manner 4 ,,I certify that in the performance of the work for which this permit is issued, t shall not employ i to become subject to Workman's Compensation laws of California." 46 ;. Signed_.. �./._..._.�'` ... ---------- Title -- .-- --- .. + --- --- By (if other than owner) FOR DEPART ENT USE ONLY _.. DATE _._../.0 /-7. _.? ---- .......- APPLICATION ACCEPTED BY -- . . DAT - ------_- - DIVISION OF LAND NUMBER --..-.- ADDITIONAL COMMENTS. ......................... .. ...... -- ._ t �.� �� .2�_.... .._........ ---------------------- --- - : Dat -- *-- . .._...�:__..--�----�- - ---_.. .................--------------------- e._-�a�17 --��'. - -- ---.... -�-... F&5 21677 REV 7/7 Final Inspectiony:----------- SAN JOAQUIN LOCAL HEALTH DISTRICT CH 13 24