77-785 - Laserfiche WebLink

Home Browse Search

w FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT —�. Permit --------------- --------------------------------------- (Complete in Triplicate) ------------- Date Issued ----------------------------------- --- 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. JP ` This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: ---------.CENSUS TRACT---------- ----------------- JOB ADDRESS/LO SS/LOCATION!zz3 `-��---� ---. -------- -r -- - --- __. _ - -------------- -- --- -_ ---- ----- Phone - 5� Owner's Name---" -- " '" //� c�>'.- .-- �-�-`------- -------- -City --- - ---- ----- -��-Zip. . . - ------ -- Address��--- - - _ -.-. .- ... — License ----- ---- one ----------- ----------------- Contractor's Nam -Lice # Ph Nam Installation will serve: Residence. Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other-------------------------- - 1. s ) �. Garbage Grinder--- -------Lot Size--,j - --0-- ----------------------- -W Number of living units:.-_-l--__----Number of bedroo s_,-.__- - - - - ------------- Private Water Supply: Public System and name ------------------------- ----- Character of soil to a depth of 3 feet: Sand ❑ Silt❑ {Cay ❑ Peat ❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe❑ k Fill Materjal----------"-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 ,arkseepage pit permitted if public sewer is available within 200 feet,] f7 -------------------- -------------------------------- 1 PACKAGE TREATMENT ;[ ] SEPTIC TANK [-�'J r Size---" __d__- ---_ --- Liquid Depth.- Capacity f� = TYP '`" ---Material----- n - No. Compartments _Foundtlrion.._ D - ------Prop. Line 'Distanceao nearest: Wel!_..1YL.v_ -:_. ,- -- --'------ - --- �/. � r LEACHING LINE- No; of Lines------- -------,,.--------- :'Lengt! .af each line-- ---------------- Total Length._".--- -------------------- � . i :D' Box-= _----- - ype Filter Ma ria1 ✓ix. --"_-DeATn Filter Material--=--J __-_ --- --- r: ,. ; Distance�to nearest rWel I--- - - ----- ------- Foundation----1 _-----_,.� Propertyine_- _- rDiameter"._ ' Number "._-- ---------------- ------ -- Rock Filled Ye SEEPAGE PIT I Depth_�"'-� = -� f Wate/Table'Depth-_/1" .Ro Size --------------------------------- -- �Z Disfance,to nearest: --- ^ Foundation Prop. Line_.--------------- ----------------------------'Date_ ------------------= - ---1 A REPAIR/ADDITION (Prev, Sanitation Permit#__'--_------------------: , 1� Septic Tank (Specify Requirements)----------------------- ------=--------------------------------------------------------- Distposal 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 Joaquin County San Joaquin Local Health District. Home owner or licensed agents Ordinances, State Laws, and Rules :and- Regulations of the signature certifies the following: "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 be e�subled to rk Compensation laws of California." Signed---------- _ --- Owner. ------------------- --------------- ---- Title----------------------- ------------------------ -------------------------- BY------- -------------------- (if other than owner) FOR DEPARTMENT USE ONLY s --- -= - -----DATE = -e--7-y7------- APPLICATION ACCEPTED DIVISION OF LAND NUMBER./ w ----- DATE ------- - -------------------- ------ - -- ADDITIONAL CO E jS J --- � -- `_"� ----------------------- -1 � =- j -------------------------------- -- -.c-�� / - t ------------------------ jc� �2------ - -- -- -- -- ---------- --------------------------------------------- ------------ -------------- Final Inspection by:----- - - ate:- ------------------------------------ Final -- - - F&5 21677 REV.7/76 3M EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT