78-195 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 7� Permit No---- ----------- -- (Complete in Triplicate) Date Issued_ This Permit Expires 1 Year From Date Issued i Application is hereby made to the San Joaquin Local Health District for a permit construc -a nd_irastall.,the-wor-k=herein described, to This application is made in compance with County Ordinance No. 549 and existing Rules a`� d Regulations: -� CENSUS TRACT -- j ""'� � i ' 1 JOB ADDRESS/LOCATION _- --- f ne Owner's Name _ 1 .1 �t rr* - !1 Zi -- ---- r a -,e- ---- -- �tY !� Address .__ >;.` `"� �]' Phon --- .��-�-. License #G -�.` .- Contractor's Name A^ �"� `.° '.� • Commercial . Trailer Court ❑ + Installation wi11 serve: Residence. Apartment House❑ ❑ i .. z :yMotel,.J I Lot Size--- r�Q �/� / cn- -- ----- Number of living units:__ -_- -_---Numberto4broorns-'.a Garba/ge�Gtinde.r:= { ivaG. �'��'�_ - ---- - to-- ---------- r'Water Supply: Public System and:name_ _f_-1. # 1 Peat Sandy Loam ❑ Clay Loam ❑ " Character of soli to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ ❑ 1 Hardpan [I Adobe Fillterial _ }- ---If yes, type-- ----- {Plot plan; showing 'size of lot, location of system in relation to wells, bvildings_etc.�must be:placed on reverse side.) ermitted if �blic sewer i5 available within 200 feet,) V NEW INSTALLATION:' (Na sept is tank or seepage p't p f Y -i" i ...i .4. - �} -C PACKAGE TREATMENT' [- ] • SERTIC-TANK Size__ 1---- - Liquid Depth `3 _-- 1Pr N ill_ ompartments.:.__. !A7- - - .o.,.0 ;-- ----------- 1 �... CapacitQ - , p� r { -� A � �{. Foundation.'_�r� __ _ op. Line-- Distance'.to nearest: W _._ l . - --- - f . i } I ---!- iLength of each line,_ -- f-- - ---.Total Length __. -- ---- - -- LEACHWG LINE ' Na._of Lnes _---.- t: ,�- *- 9 Pi __De Depth Filter Material -.__/ ---- 'D' Box. _ e Filter Mdterial /�! -- 1? r l TYP ---y / Distanc�.to nearest: Well;l ��-----Foundation._-'`_�-�- ---- --- -Property Line- -� --, - 7 ,f `, , Filled N i a��—f_ _Diameter-�-tom Number._ - � - --=- ----------- SEEPAGE -- "--- Yes� a ❑ SEEPAGE PIT Deptha� i r u --Number.--- r f -- i ..� r. �, y -Roc Size r ac Water Table.Depth- ___ -' k i. ° -- i-- - -- c%J.�- __ Foundation ---- -- -.ProLine - �Distaridto nearest: W 11./�' ------ . _ ------ ---- . --------- ----------------- ------------ Se ------- ------- - =------Date_ ------ �=------ ---). REPAIR/ADDITION (Prev. Sanitation Permit#_.C_-: � Septic Tank {Specify Requirements)-- '--------------• --=- ------------------------------------------------------ ------------- -=-----------_---- --------- ----_'.- ----- Disposal Field (Specify Requirements) -----: ,' --- -------- ------ ------- " ; - 9 i [ - - ---------------------' = -. ----------------------- eS --------------- - -- ---- t 1 (Dr existing and required addition on reverse side) G i I hereby certify that I have-prepared this bpplication 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 licensed agent) signature certifies the following: F x "ll certify that in the performance of the work for which this permit isissued, I shall not employ any personAin such manner,a± to becomes7�,Workman s Com nsati laws of California.'? EPTIC & SEWER SERVIC I = ------Owner LA 95205 RENCE'S S Signed-:_ --- 263 Sa. Oro x� ,Stockton, Calif., -------------- ------------- ----- 1 s - = Title-f------Pb.-4�a3._32Q9----ConLractar'.s_Lic<#ZfslllJa- BY } - ., . {If others h an owrierj ' FORT EPARTMENT USE O�11 ` 1s ------------- - ----- DATE._ . /7 -- = 1 ---'-- APPLICATION ACCEPTED`BY - --- s DATE-.-.,--:DIVISION OF LAND NUMBER -- i ._ __ - t q. L - 4 r[c_ _ -- -- ADDITIONAL COMMENTS. 25A�14_ --� � - - ! �.� -- _ ^s # --- - - --- ----� .. d ----------=------ ; ----- --............. --------- ---- - --------- ---T -- - t -------------------- ------------- Final Inspection b - y° ---- F&5 21677 REV. 7/7fi� FH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT