77-191 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ----------------------- - ------ Permit No.-- -- - •, (Complete in Triplicate) , 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.permit to construct and install the work herein described. This application is made in compliance with County Ordina Nd.-549 and xistin Rules a egulations: JOB ADDRESS/LO ON --------- ................... TRACT ------------------------------ Owner's Na a-.. ------ -- ------ -- --- --------------------- - Phone'�� - .p -------------- Address ----- ---- -- - -------------- -- -- ------------------- ---- --- -�CitY --- --- - -- -------------zip ---------- - ----------- -r- Contractor's Name-------- . _ '_License _Phone--- ---> �` -- -- - Installation will serve: Residence Apartment House F] Commercial ❑Trailer Court E] t Motel ❑ Oth r---- ---- ----- ----- ---- -- -- ---- --- ' Number of living units:------/----Number of bedrooms_._ __Garbage Grinder---------_--LofSize__� ___________________-________- f r - Wafter Supply: Public System and name-- -------------------------------------- ---------------- ----- --------Private Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat ❑ Sandyjoam Clay Loam [7Hardpan E) Adobe E] Fill Material------------If yes, type----- ,t_ _ _------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. mut be placed on reverse side.) NEW INSTALLA71ON: '(No septic tank or seepa a pit permitted if u lic sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC ANK [ ize. _- __ '�� Liquid Depth ----------------- ---,. --------- � - Yp --- --- —--Material_`l;rx-1-------- Compartments--------- Capacity- . - ri----T e .11 Distance to nea reit;Wel I------- - --------'f'___-___-________-«-FF,oundation_1/�----------------Prop. Line A.5. LEACHING LINE [�}�No. of Lines # , ength of e h line.{-69-aZ 6-_--_--_Total Length._�1_4_._�'4 — _ ,.� D' Box------------Type Filter Material& epth Filter Material__--/ ------------------------ 'n. -_------------------- --- ,$r Distance•to nearest: Well__5�.___________'____Foundation.-�______________________Property Line._-____-___ ___._______._____---___ SEEPAGE PIT [ j Depth----------------Diameter ------------Number---------- --------------------- Rock Filled Yes ❑ No ❑ Water Table Depth---------------------------------------------------= Rock Size--------------------------------------------- Distance to nearest: Wei/------------------------------- Prop. Line----------------- W REPAIR/ADDITIONS (Prev!Sanitation•-Permit -- _ _____. ate---------------------- ] -"'Septic Tank (Specify Requi.rements)---------------- 'Disposal --- ------------------------------------------------- ---------------------------------- L -------------- -- q ~ C Fieid {Specify � '------ -- --- K ------------- •.. I rF (Draw existing,and required addition on reverse side) hereby hereby. certify That I have prepared+�his'applicafiorrand that the work will be done in accordance with San Joaquin County r Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licensed agents ('signature certifies the following: - "I certify thbt' e'pe ormance of"th`eFwork for which this.pi; is issued, I shall not employ any person in such manner as to become`; ub' c to Workma Compposation laws of�California." Signed--- r ----- ---------- Owner By---------- Title C 1 v (If other than ow r) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------j J.R -------------------------------- ---------------------------------------------------DATE ------ ---------------- DIVISION OF LAND NUMBER.---------- -- ------------------- -------------------- ---- --------------------------------._DATE- --- ------------ ----------------------------- ADDITIONAL ----- -- ADDITIONALCOMMENTS----- ------------------ ---------------------------------- ------------- -------------------------- ------------- ------------------------- ----- ----------------$----------------------------------------------------------------------------------- ---------- ---------------------------- ---------------------------------------- --------------------- - ----- ------------------ --------------------------------------------------------------- ------- - Final Inspection by- N ----------Date------ --r---------- - ------- ------- ---- EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&5 21677 REV. 7/76 3M