77-837 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE APPLICATION FOR SANITATION PERMIT FOR OFFICE USE: - -------------------------------- --- ----- 7- X37 (Complete in Triplicate) Permit No___ Date Issued-Ze).74.777 This Permit Expires 1 Year From Date Issued I 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 Ordinance No. 544 and existing Rules and Regulations: L JOB ADDRESS/LOCA 10N, !� �-- ---`--- F -- ----- - <-. ---------.CENSUS TRACT-------- t Owner's Name i ------- ----------- ne 7! 7-377_ " Address---- �.�P o _ '� --- Cit s :..-_._._.. - Y - ----zip---------- ---- -•--- Contractor's Name.-_---- ---- ----- -----License # �� -_Phone:----------- Installation will'serve: i Residence � F } j ❑ Apartment House E] Commercial (❑ Trailer Court ❑ i ,......�._. Motel ❑lOther- Number of living units:-- --__ Number ofbedrooms - GarbaX7e7G?ri� _-_____Lot Size1 -------------------- - Water Supply_ Public System and�name-------L------------------° `_ A. ------: ------------------ -------- ----------- ----------------------------Private [� Character of soil to a depth of 3 feet.-+7Sand-[];Silt El "'Clayr] Peat Sandy Loam ❑ Clay Loam ❑ ` Hardpan.❑ , Adobe, Fill Material=_._.-------lf yes, type_-- E- -------------- ------------- (Plot plan, showing size of lot, location of system in relation to wells, buil'dings,.etc•!must be placed on reverse side.) NEW INSTALLATION: (No'septic tank `of seepage pit permitted if public sewer is available within 200 feet,) .�. PACKAGE TREATMENT''[ ] SEPTIC TANK' j;] '" ¢Size_.:-_.____---------------------- : -------=---------- - ----Liquid Depth..------------ ---- - Capacity'.__::,... "TYpe-------------- -----------Material - .------:----- i---' No. Compartments---------6 ----------------- -- Distance to.nearest: Well -- --------- Foundation-A-_ ----=_ Prop. Line------------------ t LEACHING LINE3 1 No, of Lines- _____ Length of each ling-,____- ___._ -___Total Length -__ - J .' - ----- D Box__'- -__ ;TypeFilter Material-___ - -__Depth Filter Material___-_ iDistancg�to nearest: Well - -------------Foundation ----------------------------- : -�Property roperty�Line -_- -- ., --- - --- -SEEPAGE PIT p,h _ _- - Diameter __---------------�Number'! _. _ ' Rock Filled ' Yes N -- Water Table Depth . -----------------------------------Rock Size ----------- - Distance to nearest: Well ----- --------Foundation.-:------ -- -------- --- Prop. Line.----- - ------- ---= I REPAIR/ADDITION (Prev:Sanitation:Permit#--------- - '____ a ) = Date = - ---_ -- --- i Septic Tank (Specify Requirements)-___-___ -: ._--.-- - r` ----- ---- ---------- -------- -------- --- ' Disposal Field(Specify Require ents}� (��- -- � ------ . ----- -------------------------------=--------- (Draw existing and required addit'ion;on reverse side) F hereby certify that I have prepared this application and that the work will be done 'im accordance with San- Joaquin County Ordinances, State Laws; and Rules and Regulations of the San Joaquin local Health District. Home owner or licensed agents ,.i signature certifies the following: "I certify thaf'in The performance of the work-for which this permit is'issued, ,l shall notemploy any person in such manner as to become.subject.to ,Workman's Co ensation laws..of California." l 9 Signed = --------------------------------- -- BY - ------ ------------ --- - r T In .. er E _ _ � ------ -_ -----a- ------------- -----__._-._{If other than owner} { (� FOR E .ARTMENT USE ONLY r� APPLICATION ACCEPTED BY_. = ` - --- - ---- ------------------=--- ----------------------------------- DATE._19----- -----------DIVISION OF LAND NUMBER -------- - - DATE-- : ADDITIONAL COMMENTS------------------------ - . .. ------------------------- �- -------- -------------- -Date -------------------------------- Final Inspection =- 6y:_'--- -ter.__ _---.f---- -- ,� e EH 13 24 SAN JOAQUI 1 OCAL HEALTH DISTRICT F85 21677 REV. 7/76 3M'