78-298 - Laserfiche WebLink

Home Browse Search

V FOR OFFICE USE: FOR OFFICE USE- - ,APPLICATION EFOR SANITATION PERMIT (Complete'in Triplicate) Permit No..7.... _ ---- -------------------------------- ------ Date issued. ,r-,?- 7f -------•------------------------------------------------- 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. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations; JOB ADDRESS/LOCATION---- 41....... - �-� ---------- =---- -------------- ---------- ------CENSUS TRACT..--------- ---------------- Owner's Name________ _ Q_ �^ -�}`��'- ` ' ----------- --------------- Phone �f Address----_-----�T60__ Ci _ tY -------------- ------------------ZiP--:----.._--- -- ---------- i -�Contractor's Name----- �✓ _. �``�� --------License # ----- ------------- -Phone---- - --- ---- Installation will serve; Residence. Apartment House ❑ Commercial ❑ Trailer Court ❑. " Motel umber of living units:_.-_.I_.______Number of�dro�s_ Other-G____________ ___________.___.______ .___, N 7� arbage Grinder------------Lot Size. ----- ------- I ------- - Water Supply: Public System and name --------------- ----- = 'rt' f - !`'.----------Private [ �iI Character of soil to a depth of 3 fe;yt�:�Sand 0 Silt E] Clay 0 U Peat❑ Sandy Loam E] Clay Loam E]r Hardpan Adobe E] Fill Material-. - -------If,,Ves,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 publi.c'sewer is available within`200,feet,] O PACKAGE TREATMENT [ ] SEPTIC TANK / n Size_, �/ r [tel / --- ------------Liquid Depth.__ 1 Ca acit I P Y 1 -------TYPe- A—t-Mate-rial� �-------No. Compartments---'�---------------------- Distance to nearest: Well.__..__ f - ____.___Fourelation„___._�__�7, ____Prop. Line-_ S_ ______._. LEACHING LINE [4o. of Lines_------------ --------________Length of each line,...... ------------------- 'D' Box......1-_.__Type Filter Material------S9____-Depth Filter Material__.__``j'------------_----------------------------------- t Distance to nearest: Well :Foundation.;^�_1.10_ --- _Property Line--- _ SEEPAGE PIT De th..__?iS�iameter.____ _Number--------- ' _ _______- - Rock Filled Yes No # Water Table Depth Lie ` Rork Size �'A, � 3--------'--------------- r Distance.to nearest: We11.=_.._- -_� _. IFoundation”,_.___p0_. Prop. Line---- REPAIR/ADDITION __v"_ '---------------------t---------- -7, /.Date------------------ ------- Septi --- REpPAIR/ADDITlONy(Prev.gSanitation Permit#_..-.__._�. _ r3 Se tic Tank (Specif . Re uirements]_____________ -- �. € I , Disposal.Field (Specify Requirements)------ ------ ------------------------ - -------------•------• ---- •-----_--- ------- == ------------------------------------- z ----------- s : ._ --------- ------------------------------------------ -------------------1--1--------------------------- ---------------------- --------------------------------------------- ---------------------------------------- --------------------------------------- ----------- (Draw'exjs'ting -------------------- ---- -------------------------- (Dravu'existing and required addition on reverse side) I hereby certify that I have prepared this application and that tate work will be doner in accordance with San- Joaquin County Ordinances, State Laws; and Rules and Regulations of- the E San Joaquin:LocalHealth 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 Wo7kKs Compensation laws of California." I I Signed---------------=-------- Owner BY = -e Title '-1---------------- t other than.owner) FOR DEPARTMENT'USE ONLY APPLICATION ACCEPTED" BY---_: _ - DATE...... r DIVISION OF LAND NUMBER. - ------------------------------------ ---- -DATE ------------------------------------------------- ADDITIONAL ------ ---------------------------------- ---ADDITIONAL COMMENTS -- --------------------------•--------- -----------------I ---------------------------- --------------------------------- ------------ --------------------------- ------------ ------ ------------------------- k ___________________"---.-___._______._____-."---._._______"-___.-____ ___ _ _ I ___________________________________________________ _______ _____ ______ ___----- __f ----.----------------------------------_ __ _____-_---------.-___"-._.___.______. Final Inspection by:......---------- --------- ---------------------Date- ----- �.-, @H 13 24 SAN JOAQUIN LO L HEALTH DISTRICT F&5 21&77 REV. 7/75 3M