78-96 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ,: FOR OFFICE USE: APPLICATIONTFOR SANITATION PERMIT .................. rI Permit No...`;1.7.. (Camplete i Triplicate! Date Issued.-" ----:-..-- ....... ............................................... This Permit Expires 1 Year from Date Issued l Application-is'hereby made to.the San Joaquin Local Health District for a perm construct and install the work herein described. This application.,is made in compliance with County OrdinanceLNo. 549,-O�_�d-_-existi�ng ules and Regulations. JOB ADDRESS/LOCATIN" :`L�. - --- .. ... ��r CENSUS TRACpT ` [.,�...._.-..Owner's N!ame.1...... . ..c � , - Q -- ------- --- Phone15'/_)"/-F - ...__.... Address---------------- --- P`4_ JL 0. .. . . - - ----City--- ....._..- ...zip--- ....-... ..License #.. .r� .: .....Phone- '96�'T...--- - nn .. Contractor's Name- t `�- ..... Installation will.serve; s. Residence X Apartment House ❑ Commercial ❑ Trailer Court ❑ j Motel ❑ Other. --- -- -- ------------ Number of living units:_..I::-....Number of bedrooms.....0i....Garbage Grinder-...........Lo ize.-- _!_; .. . Water Supply: Public System and name--_--------- - - - Private ❑ Character of soil to a depth of.3 feet: Sand ❑ Silt❑ Clay ❑ , Peat ❑ Sandy Loam ❑ Clay Loam ❑ { a 'Hardpan ❑ Adobe'4 Fill Material.. .... ..I If yes, type................_-----.-- -... (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 '� Size.-........ -�X--i�----;:---- •-- --- ---Liquid Depth.--- ----------- r Capacity.1.�t!x-.-..-- Type--- Material.... ._-.:No. Compartments------dam--------------............ t a: Distance to nearest. Well------- ---- -- .....Foundation....- ----.-.--....Prop. Line-_ ------- �Q r No, of Lines ......... . ... . LEACHING p p ff - Length of each line.... ... Total Length ...... - 'D' Box,---, --...Type Filter Material...)Ifov`•c..-_Depth Filter Material--- ................ .............. ...... Distance to nearest: Well............................Foundation.. Property Line....-5.............. _..-..---•--- . f - rr SEEPAGE PIT jyQ Depth...72,n�--.-Diameter...... . .-. ---Number.------�r---- -------..--- Rock Filled Yes No Water Table Depth------_------------------- --------- --------------------Rock Size... ..X-I- �-�------ -- -=•---•--- � Distance to nearest. Well---------------------- ----------------- Foundation .T__....Rrop. Line../Q....1..__........... REPAIR/ADDITION (Prev. Sanitation Permit#---------------'------ --- ------ .... - :..D.ate..... ........ ...................... Septic Tank [Specify Requirements] - --=---------- ----- Disposal Field (Specify Requirements)- -- ------------ ----- ...---- ...... --- ----------------------------- ------------ --- ........%----------- -•------------------ -- ---------------------- ........... i-----._...----- ----------•-- ----- --------- -----------------------------------------•------ . ............•- ..------------------------- --. ----... ------------ ------- (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 Joaquin County Ordinances, State Laws, and Rules and Regulations ,of the San Joaquin Local Health District, Nome owner or licensed agents signature certifies the fallowing: " i i --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 become subject to Workman's Compensation;taws of-California." Ma. Signed----- ... r ............ .__Owner ` By......... ..- ..... ..........Title.--- ............... ----------- ........ (if other than owner) A,.�- FOR DEPARTMENT USE ONLY i APPLICATION ACCEPTED BY- -------------------------DATE ' DIVISION OF LAND NUMBE - ------ DATE.. :, .......------ - ----------- --------- ------------------- ADDITIONAL COMMENTS---------------- - -- ..---.--- �,, --- ..--------- ------------------- - --- ------ - --------- ---- 3 15 `� I --------------- . ......--- r.......,... --•-•----------------------------------- - - - Final lnsp+3Cilan b ...Date_-.. -1- --...-_ y:...--- _ --.... ... ---- � EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&5 21677 RE��M