77-1039 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -------------------------- ------'---------------------- Permit , X+ NI in Triplicate) ---------------------------------------------------- '. w Date Issued._/� :a7 77 ------------------------------------------------ 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 9nd Regulations: ' CENSUS TRACT.-_ JOB ADDRESS/LOCAN - �-A--QI .- --------------------------------------- �-------- ----=-- � �� -------------- _Z 401, Owner's Name._-. i ---- -- ---- --------:-------------- -- --- Pho --- ------------- ---------------- - r Address----- --- ---- 'e� ----------� -----.City _. : - ZAP Contractor's Name______- _ License #-._ 7l5 ________.Phone = _ 9 Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ i .._ .. Motel ❑ Other----- --- Number of living units:-.--___.-__--____Number of bedrooms-.------I----Garbage Grinder-.-- Lot Size----- -------------- _--.____----.-.----� Water Supply: Public System_ and name.---_ ---------------------------------------------------- ------------- -------� F.- ------------------------------ ------Private Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑Peat ❑ Sandy,Loam�❑ Clay Loam El_ _ .._ _ Hardpan Adobe ❑ Fill Material__._-.--..--If yes, type___ _________________ k At(Plot plan, showing size of lot, location of system in relatio n to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: -(No:septic tank or seepa a pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK [ Size_____ I'__4 _______-'--:-' ""_- ----Liquid Depth-Ca otic // ---_ --Mate•rial_.-- ----------------No. Com artments-- -__-- - - }p y-IA-�P----Type J4 , PDistance to nearest: WelL_--.- .8---------- ----------- 10 =Fo,ndative.-_�d.- Prop. Line LEACHING LINE [�No, of Lines-.---s _____---.--- _--- Length of each line �-_:-__ C3-_�/�.-Total Lengl� .__,l Q____.D' Box.-_��Type Filter Materials e&41- _-Depth Filter Material-.---____18-- ----------------------X- -. wDistanca to ntearest: Well- __ Q _�___ Foundation--. _Q_---------------Property Line---_76---__e .� . -_t__Number-�-------------------- . Rock Filled Yes ' No. SEEPAGE PIT [ Depth.- _____ Diameter-.-Bb_-- �� ` _ Water Table Depth-�_'_��-C� ---------------------'-----------Rock Size--- ---- �.3 . Line.-74---- --- _ - � - - r--------------- -�Foundation ��--------------------------- -_ lk � Distance to nearest: Well-..---- -�-. ,5_ -------.Pro REPAIR/ADDITION.(Prev. Sanitation Permit#------------------------`-------------------•------Date------------------------ ------------------- Septic -- .----------Septic Tank (Specify Requirements)-------- --------•------ ---------=---- ------------------------- ---------------------------------------- ---------------------------- Disposal Field(Specify Requirements)----- --.-- � , ., :------------------------------------------- ------------ ------- ---------=--------------------- -------------------:------ --------------------------- ------------------------ i ----------------------------------------------------- --- -- -- ------------------------ ----------------------------------------------------------------------- ---------------------l---------- {Draw existing and required addition ori 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 work for which this permit is issued, I shall not employ any person in such manner as to beco b)' ct to W man' Compensation laws of California." ,. Signed.- --- ------=------------ Owner �.. Title---------------- ----------- - - --------- By - - - ' (If other than o. er) FOR DEPARTMENT USE ONLY- r T 7. -ATION ACCEPTED B -- - = DATE _1 -." a T OF LAND NUMBER ------=------ ------- ----------------------------- -------DATE.-.----------------- - - 3 COMMENTS- -- - -----------------=------ ---- ------------------------- --=•------ ----------------------------------------------------- ---- ----------------- ------------------------------------- ----- ----------------------------------------------------------------------------------------------------------------------- --------------------- -------------- ,• .. � (jam - - Date ------------------------------------------------------- - - ------------------- ---- - -- - J SAN JOAQUIN LO L HEALTH DISTRICT ras s