79-444 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: --------•- .... APPLICATION FOR SANITATION PERMIT FOR OFFICE USE: (Complete in Triplicate) Permit No. . - _ - - P rm� ]9'-S/cf '.----- h Datedssued-r5--�..,�.9-29 • -•' ---'•'.. --- . .- . -- - This Permit Expires 1 Year From Date Issued .Application is hereby made to.the SaniJoaquin Local,Health District foraermit to n p '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/ � x DDRESS/LOCAT N, -- -- -- ---- --- ,--��it r-- -"/._�.... .....-----------CENSUS TRACT..-.-- Owner's Name,.- ` .-'b`�..--: ._...f �� .�X� Addres -------- Phone.... ----------------- s :!�j �i�. �3n. , --. ..- City. zip--? Contractor's Name. i.L,_. License # -. l_ Phone-- . - �-.1��'t 1�G°`<- - �.-~�.- Inslallatiori will serve:t�'. Residence Apartment House ❑ Commercial ❑ `:,,Trailer Court ❑ Motel ❑ Other- - Number o f living units:._ +- Number'of. drooms_-- /� -..._Garbage G i er_, Lot Size.,-(� Water Supply: Public System aril Warne..'. . _ ------ -1 � ,f.�' 7 :1� __ Private Character of soil to a depth'of 3`fe t:� .. Sand ❑ . Silt❑ Clay ❑ Peat ❑ Sandy Loom ❑ Clay Loam ❑ Hardpan-t) JAdob Fill Material.. _. - If yes, type.---------------- ---------- (Plot .- -.-(Plot il plan, showing size of lat„.locat.ior3 of system:in relation to wells, buildings, etc. must be placed on reverse side) y NEW INSTALLATION;� _ ` (No septic .tank or seepage pit permitt`ed_if public sewer is available within 200 feet,} h; ` � --- ..... - ePACKAGE TREATMENT 45EPTIC TANK Siz ...... ....Liquid Depth.-`.: �. Typeo. Com artments__�- .... ...Cap _ , ......;U Distance to f nearesf VlJell s--------------------Foundation.-._ --�.---.. Prop. Line__:-- ------------- - r LEACHIN G'LINE Na. of Lines .. -...--..............Length f each line --__ .-�---. ._. Tota! Length ...�/�,1..------- ............. 'D' Box....1-. Type Filter Material- YP -. - --...Depth Filter Material--._-- --� - ---------•---------.-. --- 3 Distance to nearest: We1L- P..... .--- .----- Foundation---- _---_____.........Property Line..._ ------------- `s .. - SEEPAGE PIT �[ F_DepthJ :-Number,,_.. ----. ------------ Rock Filled Yes4 No.❑ i Water Table Depth ...... 0-__... _--- ------------Rock Size ... �O / Distance to nearest: Well.... t�..(/-------------------- ----Foundation......_ .-- Prop. Line..-.-,5 .-------- REPAIR/ADDITION ..-._REPAIR/ADDITION (Prev. Sanitation Permit#------------------ Date............... ) ........ Septic Tank (Specify Requirements)_------- ---------- -------- Disposal Field (Specify Requirements)............ _._ . ---------- - ........................ -_. ---------------------------------------- .----- ----....._. ._....-- - ---- --.... ` (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 aoaquin County Ordinances, State laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or:licensed agents signature certifies the following: "lc 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 betoine. subject to Workman's Compensation laws of California.” CLARENCE'S E T!C & SFNt IER SEP';rICE Signed .. Owner 5205 BY - _.-.. 263 o Ora SEa 1 r Title . _Q3_� !a ---C_ ILi' Etor's Lie,�T2u21LL (if other than wner) FORD ARTME TUE LY' APPLICATION ACCEPTED.BY -- .........DATE ..._..". f`;� - DiVISION OF LAND NUMBES-3_.- . DATE ---- ADDITIONAL COMMENTS 9..:_-...,.. _:. _ --....-. --- ----.----------- --- .... < - ,,..,,.�, .. —-.- . --..- f Final Inspection by: .. "' e S -�- - - - - ----- --- - - -------------pat -- --� =: -- -may'.- --- _-. ...--- eM 13 24 S AQUIN LOCAL HEALTH DISTRICT eas 21677 Rev. 7176 3M ; i