78-269 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT permit ..............•-------.............. - ------- - (Complete in Triplicate) J� Date Issued.-T--.-- --- This ssued.-T - This Permit Expires 1 Year From Date Issued A lication is hereby made to.the San Joaquin Local Health District for a permit to construc .install the work herein described. t and' pp This application is made in compliance with County Ordinance.No, 5a9 and existing Rules and Regulations: ✓ ` L r CENSUS TRACT------------- ----- ------" ....._ JOB ADDRESS/LOCATION..-.:.-...."... Phone Owner's Name.._. .: --- . ........ ' Address--..---------- --- � : / --49'k-- I one_ L'cense #,� �f if Contractor's Name .. w�:, .- .., Installation will serve: Residence , Apartment House ❑ Commercial ❑ Trailer Court ❑ Itel ❑ ------ -- -- -- --- -' Number of living units:. -_�..,..-...Number of bedrooms.... -...Garbage Grinder....."---- .-Lar size-"- - { U Pri ate ---------•-- ❑ Water Supply: Public System and name...- .. ----- --------- .........t�J�.I Silt Clay Peat ❑ Sandy Loam ❑ Clay.Loam Character of soil to a depth of 3 feet: Sand ❑ ❑ Y ❑ , Hardpan ❑ Adobe❑ F"Il.Material _ :-'f 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,} Size ... f �.� 1---•--....--- --- Liquid Depth... /'- - PACKAGE TREATMENT [ ] SEPTIC TANK [ ] .. i aerial...�' T� .......No. Compartments 5 Capacity...r. 19.49 -TYPe.-- .. .. .� Pro Line--- ----- k Distance to nearest: Well..'.:...:.. ..- Found"aSion j'----. P Len th of each fine._.. Total Length .. -- " k LEACHING LINE ;[ ] No. of Lines _...-��- --"-- g Depth Filter Material_.. . - V_ — ,.- :- .�.. 'D' Box... I.....Type Filter Material..-/ -- �•-- P � ----- �----� - Distance to nearest: Well../.„ `� t Foundation-- 117-0......-- Property. Line----• ---•- . . .• Diameter.... ' .. Number..------ --- Rock Filled Yes No❑ SEEPAGE PIT [ ] Depth Rock Size--.----... Water Table Depth--------------------- J ---- � -- ---...Foundation ------ -...-- �- .. Prop. Line._---.....-..- Distance to..nearest: Well------- --- - ..........Date --------- REPAIR/ADDITION (Prev. Sanitation Permit#.....-_-_------ ---- ----- ---- -} Septic Tank (Specify Requirementsl.-.- --" ....... --------------------------- - -- ------ ------- Disposal Field (Specify Requirements),.... -- ----------------- ----- ' --------------- ---------•---------- k (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: person in such manner as k "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any p l to become subject to Workman's Compensation laws of California." --------------------------Owner Signed-....- --- B - (if o er than owner) F FO DEPARTMENT USE ONLY DATE .... V. -7 -:...... ......... APPLICATION ACCEPTED BY /Y+^< '- ---DATE--- --------- ----- :._.-.-------..--. ADDITIONAL COMMENTS-------------------- ----- -------------------- ----- .._---------- ---- ... .--... 'DIVISION OF LAND NUMBER.------------ - ----- ----------" " -------------- --------... -- ------ ------------------------------------ -------------- •--- ------------ a _....- _ _ LIN . r. Date__ ... Final Inspeciion b . Y F85 2167 7/76 37 Ex 13 24 AN LOCAL HEALTH DISTRICT /�•