77-530 - Laserfiche WebLink

Home Browse Search

FOR 9FFICE USE: T. 6' T, r . APPLICATION FOR SANITATION PERMIT FOR OFFICE USE: - (Complete in Triplicate) Permit No,__ �Y-3 -------- --------- This Permit Expires 1 Year From Date issued ----- - Date Issued ._ _5;�-�_ 7 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 existin Rules and JOB ADDRESS L T. Q regulations: Owner's Name r -------------CENSUS TRACT--- - Address-.- a _.4.F.1. - ( 1Mf-" -- _ - ...-. .... -Phone_ Contractor's Name- -_,-.- City. it Lfs•..+ zi Q -'- P ----------- --------- _,e " - ---� -- -- License # _ Installation will serve: . § Residence -�------Phone..�._6"ji�rD Apartment House ❑ Commercial �• --- Motel ❑ Other___ __ __ ❑ Trailer Court ❑ Number of living units:.-- - -- ---- - --" ---- ---------- ------.-_Number of bedrooms _-_ __--- g Garbe eGrinder_____-•-----Lot Size------ --IQQ/Z Com+--------- Water Supply: Public System and name__ _ _ Character of soil to a depth of 3 feet: Sand ❑ Silt Cla ------------------------------------ Private Hardpan ❑ Y-❑. Peat.❑ Sandy Loam ❑ Clay Loam P ❑ Adobe Fill Material.- ,--- -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 tic t k or see age de.} �—V— PACKAGE TREATMENT g pit P itted if blic-s er is ila wi i 0 f t,} l / d C petit _ -- -- - par = e oda lo ---------- - --- LEACHING LINE ------ -._ , Prop. a-- o. o Lin -._ Le �hofea Ina _ "�� -- - - - ------------- k le ------ To nth -�.D' Box._----.---T g -------------------------------ype Filter Materia ____-_ 'Depth Fitter Material____ : " ----- -- Distant o n crest: Well/ Q E "Zoo ------- SEEPAGE --.- SEEPAGE PIT - ----------------Foun tion--------------------Property Line .' Depth. ----------- -------Diameter_._ ------------ Water Table Depth---- - f ---Number---: ------------- - ?'Rock Filled Yes g, No � .z IY., =-Rock Size , '4 ,� 7 `/ Distance to nearest: Well.- _-�_-Q_ • --- -- ,---Foundation-----/_L ` 1 .r+ _ to ------ REPAIR/ADDITION {Prev. Sanitation Permit#-_------------- ---------.Prop• Line --__ ---------------------F:Date: = = w Septic Tank (Specify Requirements)---------- -- --- } Dispo.al Field (Specify Requirements)_._-_ -,--- - '---------- ----- ----- - e ----------------------------- V --------- ---- ---------- ------ ----- --- -- _r_ 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, Home owner q ts signature certifies the following; or licensed agents "I certify that in th4,rformance of the vvJ6rk for which this permit is issued, I shall not em to an to becom subject orkma 's Comt tion law of California." p y Y person in such manner as Signed. wr 1 ---- nt Q BY------------------------------ (If other than owner) - Title-_ �RDEPARTMENT USE ONLY APPLICATION ACCEPTED BY01DIVISION OF LAND NUMBER.----------- .._ - -------------------------------------DATE . 6 ---------- ADDITIONAL CO ENTS _- ��- :•fry ------------------------ -------------------- --- DATE- ----------- -- ---------- -------- _ o .7 ---- ------------- -- ------------------- ----- - =inel Inspection b �Xe_/sc Oma' --- . iH 13 24 I--------------------------------------------------Date.- --6 Z. 6--7 SAN JOAQUIN LOCAL HEALTH DISTRICT F&S 21677 REV. 7/76 3M