77-297 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ----------------------------------------------- Permit No.--- -- -- - - - ---- -`,----------f---•----- ----------- - (Complete in Triplicate) Date Issued -7 --. # This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein described. This application is made in compliance with County.,;rdinance_NV_"S49-arrd existing Rules and Regulations: JOB ADDRESS/LOCATI,ONW'A_ .... { ---------------- -------- --- - CENSUS..TRACT. Owner's Name Phone=k Address- �o---- ---- -- --------------------------City----- ----------------------------- Zlp s i i Contractor's Name------ - --------------------- ----- -License Installation will serve: Re-sidencepartment House ] Commercial El Trailer Court ❑ ; . +L tel ❑ Other------------------- ------------------------ Number of living units:-`-j-:----_-Number"of bbeclrr"oorns:------Garbage Grinder_--------_--Lot Size_-" - ---1_ _- __1__________________________ Water Supply: Public System and name____ ------------------------------------ ----------- --------------------- --- - ------- El . Private Character of soil to a depth of;3 feet:' Sand E] -Silt ❑ Clay ElPeat ❑ Sandy Loam Clay Loam ❑ r } :Haan rd P ❑ Adobe ❑ Fill Material__ -. If yes, type-------------------------------- k ---- ------- --- ------------k {Plot plan, showing size of lot, location of system in relation to wells, buildings,.etc. must be pllaced-qn reverse side.) NEW INSTALLATION:' -(No`septic tank or seepage pit permitted if public sewer is available within 200 feet,] PACKAGE TREATMENT [�l ';4SEPTIC TANK [:] Size- Mate --.""� Liquid Depth___________________ �' € �� '1 t Capacity- --�-PR___ Type.--. q. - _ - No. Compartments__-" Distdnce to.nearest: WeIP_ -- _- - -- --_-- '---- -Foundatian.-'_- '-_'--,-" Prop.'Line_"_'-------------------- -- _ _ , - ---------- -- yLEACHING LINE (�] No. of Lines------,---------------------- Length of each line,__-.=_,/fP----------------,Total Length.'_.100-_--- ---- _,------- #' D' Box-----�_.:--Type Filter Material------ -Depth Filter Material-:--`-- ---------------------- ------------------------�- ox .., pe Fil.._.,,. ..teria -IA .�... ..� ....-..�--_..�� ---- .- �-.. Distant&to nearest: Well----------------------------Foundation.--:-----__-_;_.._____"-.--.,Property,L:ine-_.__._____- ----------------. y - . . . - t: [ ] DeptlR_X--/P'.�-1t/r'ameter-`------------- Number---=- -------—-------------'- Rock Filled Yes No ❑ t Water Table:Depth-----------------------------------------------------------Rock Size-------- -- ---------------- Distance to nearest: Well-'.: -----------Foundation------ - .Prop Line----------- --�-- I REPAIR/ADDITION (Prev. Sanitation Permit#------------------------------------=-------------Date--:-------------------------------------- ----1 Septic Tank (Specify Requirements)_= ---- ------------------------------- Disyposal Field(Specify Requirements)----- =-- ----------- -- --------------------------------- -------------------- -------------------------- i -------------_----------- ---------- ----- --------=--------------------- - --- ----- --------- - ------------------------------------------------------. -----=-- -- -------- - - ----- --------------------------------------------------- ------------------------------------------------ ----- ------------------------- -------------- ----------------------------- ---- (Draw existing and required addition on reverse side) I h1reby-certify.that I have prepared this application and that the work will be done in accordanceLwith San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licensed agents 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 become. subject to Workman's Compensation, laws, of California." 6� Signed M:: ( ._ wOwner ------- - -=--- ------------------- BY = Titls-.- .. .= - -� in � - i FOR-DEPARTMENT USE ONLY ," F _. ,. �D. Tr1 APPLICATION ACCEPTED BY----- -------------------------------------- - ------- -- ----- ._ ------ A E DIVISION OF LAND NUMBER----------- -------- - --------.DATE.-..: �: ----------------------I - ADDITIONAL COMMENTS--------------- ------'------------ - ------------------------------Y- ----- -------- --- --------------------------=----- -------------------------------------- -------------------------- -----------------------------:---- ----------------------------------------------=-=-=---- ---- -------------------------= --------------------- ------------------------------------ ---------------------------------------------------- ----- ------ ------- - ------- ----------'- - ------r""------- -d------------------------------------------------------------------------------------------- ---------.-.----------."- � 6 Final Inspection-by: - ----------------------------------------------------- ----- -------------- - -------Dater--r---- -- - , --------- EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&5 21677 REV, 7176 3M