79-629 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No..*7.9-'--- .Zl 4 (complete in Triplicate) .................................... -- ...... .... Date Issued-...-...-...`.._ .. ------------------• ............ ............ This Permit Expires 1 Year From Date Issued 0(0S-- X30-0 Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work h rein described. This application is made in cam h nc with County Ordinance No. 549 and existing Rules and Regulations: �/ .� d IcIr*�1 JOB ADDRESS/LOCATION. � ..... iorw .... '..f , -1' l (Y .SGT.-......... .... CENSUS TRACT Owner's Name......... -C../� .. �.: .^ ...-- Phone -- :..P7.f. �j `_ may, -/• •-�---- 1 f^'( IT l�"lt r �L 1 CityL.f" ........_ ... �ip...' .r Address.... -�.-.. Contractor's Name........ . � .._ ...----- - ----•..:............... ... .. --License # ----- - ..........._..Phone...-.- ....-- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other------ r. Number of living units:......-.-....Number of bedrooms...--Garbage Grinder.-.- fi --..Lot Size...... �„� ',�f .----Private [ Water Supply: Public System and name-................ .... --------------------- ----------------------- -------- - --- --------------• ------ - - Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam Hardpan ❑ 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 septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ J SEPTIC TANK Size_-_,- Liquid Depth.-- ..----- V) [° `A " No. Compartments----- ........ *..-------- Capacity..j+ ' - - TYPe ...---..`..--- Material.._...Q!�`� '---- r � Prop. Line..-. Foundation.... .. ...... - Len th of each line-... - Total Length ...--.-- Distance to nearest: We LEACHING LINE [ ] No. of BoxLines.-.- Filter Material_g .- - � -.. -- - �� X--,-.Type �"� ... Depth Filter Materia ...... . ... ..... . --- :... Property Line.... - Foundation..._ ----------------••---- Distance to nearest: WeIL....f..: ��--- SEEPAGE PITX Depth...,;.. ....Diameter....- ------------- f Rock Filled Yes ❑ No ❑ .�.----------Numberjr Size...._...e .'fiL-------------------------- / Water Table Depth.----------- D-------- ---- � � .Pro Line................ Distance to nearest: Well......� -----,•---••--.•• -- .....Foundation-.-.. ---- --------- P- REPAI VADDITION (Prev, Sanitation Permit#.... •----•-- Date_----------- ---...... - j Septic Tank (Specify Requirements)------.. --- - Disposal Field (Specify Requirements). ......... •----........ ........ ------------ ........................ -------•------------------- - -----• --- --------------------- --------- 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 or licensed agents signature certifies the following: "I certify that in the performance of The ork for which this permit is issued, I shall not employ any person in such manner as to become deject t W rkmc 's Co en a ' laws of California." . .: Signed. Owner r e+' ... ..... -- -- .---- ...-- •-----•---- - --- ..................... ' (If other than owner) FOR PARTMENT USE ONLY- APPLICATION ACCEPTED BY--:..... ....�........... -- ---- = DATE ... . DIVISION OF LAND NUMBER..:-------------- .. DATE-----`......--- ADDITIONAL COMMENTS---------------------- - ----•---------- ......... --- .............. Final Inspection b - --------- ----- ate-------•---- ...... ---•-•--..._.. f35 21677 REV. 7/76 SM ` Eµ 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT