79-506 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT j ...... .`:_:_s .-•- -� .._ _tcomPleteIn.Triplicatel _-� � _- � Permit No. ._.'7q-!5()6 . I .......:.,..~........... ....... ................... ----- This Pern�i!Expires 1 hear from Date Issued Date Issued Application is hereby-made to the San Joaquin Local Health District for a permit to construct and install the work herein . described. Thisr application is made incompliance with County Ordinance No. 549 and existing Rules g and Regulations- ..... egulations: JOS ADDRESS LOCA2,..._. U / � ....�__ _..�.r:r ............. CENSUS TRACT ................ .. Owner's Name .._.. _ - . Address , -- - — _......... �_ j....'_T:.-,_.� ..+....Phone . •----- Y -- -•- • _ k ---.... Contractor's Nome -- #347.J11' 11 p ...__.. City ------- -•-.License X347. :11' 1 • Pho er- .. Installation will serve: Residence❑Apartment HOusso Commercial oTrailer Court 0 Motel ❑Other ---....... Number of living units:__ ._ Number of bedrooms �... _.. ......Garbage Grinder ._-•---..... Lot Size ---�.Z.�---70..........v.... Water Su x pply: Public S stem and name � �` t Y �.....----•-•---••---•••---........... Private .............*.-•t`"--5--•----...Ari tEs�] • P. Character of soil to a depth of 3 feet: Sand Silt clay 4 I f`v, b Y Peat Sandy Loam 0. � Clay Loam 0 i Hardpan p Adobe❑ Fill Material ............ if yes,type ' (Plot pian, shov;Ing size of lot, location of system In relation to wells, buildings, etc, must be 'Placed,on reverse side.) f NEW INSTALLATION: JNo septic tank or seepage pit permitted If public sewer is available within 2004eet,) PACKAGE TREATMENT [ � SEPTIC TAMC{ ] Size.__ yy _ - -�1-•- ... - .. Liquid Depth { Ca acity Type Material. - _ ...-____ No. Compartments _.. Distance. to nearest: Well Fou dation _.. _ --••-----_-- Prop. tine . . _..... .� -7........ ING LINE LEACH Cil»rt o: of Lines --�---•---------------- Length of each line... _ ..... ....... Total tent i i .` - ---- �''D' Box ............ Type.Filter Materia - 7 - �. r Depth Filter Material --- -•-------------- I Distance to nearest: Well oin ation _..le.._---- Property Line . '_..._ �•� SEEPAGE PIT [ ) Depth A-6 Diameter -----�--- �+� .-...... Number f -- - -•j••---•----•-•--.... R Filled Yes No 'Water Table Depth , i .........._Rock Size I �a .................... Di`stance to.nearest: Well ----_......_•- ..--- F Prop. Line ...................... REPAIR/ADDITION(Prev'--Sonitation Permit# ty ----------------------------- --. Date ...:...:.._�. ) F - Septic Tank (Specify Requirements). - i ................. Disposal Field ISpecify-i'Requirements) --•----•...._•-----.....--•---... r : ' Y_ l (Draw existing and req(Yired-addition on reverse side) l hereby certify`#hat F home 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:Dlstrict. Home owner or licen- sed 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 FRpensation laws of California." Signed _ Owner ------------- ----- ----------- SY Jitle - (I oth r than owner FOR DEPARTMENT USE ONLY APPLICATION .ACCEPTED SY _.._...:-•--- .:...... .............:...... ...DATE_.,.._. AUILIJING PERMIT ISSUED ............................... ©ATE ...__..- ADDITIONAL COMMENTS . -------••-----•-----••- -•- . ---•• - • t.. _.._....._ .. -------•-- ---- -, ..e --------•-•------ ............ ............ ------ --- �• final Inspection b . y: .. Date ............. ... Eli 13 2L 1-58 Rev. 5M AN JOAQUIN LCiCAL•HEALTH DISTRICT j3� M