78-825 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ' ` ` I FOR OFFICE USE: PPLICATION FOR SANITATION PERMIT Z� �,� (Complete in Triplicate) i Permit No. ._ .. -- ...........---•---------------•............--........... Date Issued.-_----- a� - � ....... •.... .----....-- ..-- --.._".. This Permit Expires 1 Year From Date Issued I Application is hereby de to.the San Joaquin Local Health District for a permit to construct and install the work herein described. This applicatio ' de in compliance with County Ordinance No. 549 and existng.Rules and Regulations: y I .. JO ADDRESS/L ATION .....-. _CENSUS TRACT------------------ -- ". .. ...---•- ---- .. . Own e _!/ Q .---- . . ---• --• 02 I ................ Ph e �+ .`�7J�.Seo c/ Address,/A$P . .•.- Dw t ds�Sy .. l City ZiP Contractor's Name `. �� r ------...---•- . --.License # ,7_X.57.3 Phone. -: / _._.... Installation will serve: Residence E] Apartment House ❑ Commercial' Trailer Court ❑ Motel F1 1. , 9units:.... i. g Number of living units:.............. Number of edroo s_ Other.Garba e Grinder-----F......Lot Size__ .................. tj ---- - ----- ---....---------------- [..........................-------------- -------• -.--------.Private Water Supply: Public System and name._ _ . Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam ❑ `❑ - - Y YPIi - Hardpan'• Adobe Fill Material . ._ kf est e_.._. (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 public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK Siz 7 ..__.x X ' (�' - 'lam --s -�-�_, 8� ---•---- --------.Liquid Depth.. . ............... - --. Copacity �.V_____Type_ - Matexial.(�r93't-C1.__.----.No. Compartments------_•--c ------ ------------ Distance"to nearest: Well.__.A.&I...........................foundationProp. Line...r1 -.- LEACHING LINE No. of Li'i�es..__--. _.... g 5/ C �� L�Q.*---- ---Total Len th _...1 AAO.. ....................... I .� p?-_...._..:_ . Length of each line._ ._ .. ____ D' Box Filter Material_.__...r_�.I]epth Filter Material.----- /J-------------------------------------------------- is --.'X.--., � S � i Distance*to nearest: Well--,16-0_��.__........Foundation---........::...........Property Line- .._..._........._ ........ _./ SEEPAGE PITA Depth._�5.. .._Diameter....� Number...... .-. -'�____.,..__-- �r Rack Filled Yes ' No ❑ Water Table Depth-----144---------- - - -------------------------Rock Size._p7)C Distance-to nearest; Well....IS..d------------- dation.__.4?4...............Prop. Line.f4.-........__._ REPAIR/ADDITION Prev. Sanitation Permit#------------------ --- Date ------------- Septic Tank [Specify Requirements) ------------ -------------------- ---.---- i3 ---------------- ------ --- Disposalfield (Specify Requirements)---------------------- -•.............-- ...----------------------m-----------------------------------------I- ..........................................................----.------•--................------....__.....I.................. ------------------------ --- .........----------------------- -------- -------- ------------------------ -- ..._----- _ Il II[ ----..- ..-- . -------- ---- . ......_. -- --- ---------- --------------------- ------------------- ---- - ............. (Draw existing _ and required addition on reverse side) I hereby certify that 1 have prepared this application and that the work will bel done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District, dome owner or licensed agents signature certifies the following: 4 "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 beco bi ct to rkm 's Compensation laws of California." ) Signed. .. .. r . . -- ... Owner Title.----- BY-•---------------------------------------------- ----�J - --------- ........ (If other than owner) OR PART NT US ONLY'J APPLICATION ACCEPTED BY------.' .-. ! 7� ------------------DATE..-- -- -¢�- - --- DIVISION OF LAND NUMBER.----- ..... -- --- --------------' DATE.--................ ....----- -- ---------- ADDITIONAL COMMENTS............_..- .. . . -----..---i. ----------- ----------------- _.. •-•----•------------------- ------- -- ---- --------- --------- ---------------------------- ----------- --- ----- -------- .-- ---- 1 I ................................................. ....._..____.___...__-._.___..._...._...-._.........._._...._...""-._..--• __ -._--..__-.--.__.---__._-...._..--..-_._.___.........__....--_____-_.... ------------------------------------ ...._ _ .________._.__..-___--.----------..___ I____...._.- _.._....._ ___.- _.... ___.......... .._..._ .. Final Inspection b ----Date.------..ti0- S-7 Y= b-as-� 'I a - EH 13 24 SAN JOAQUIN LOCAL HEALTH DIST IRICT f&s 21677 REV. 7/76 3M