79-626 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: FOR OFFICE USE: APPLICATION 'FOR SANITATION PERMIT I - -------------------- ---�------------�- No.7�'�-�--� {Complete in Triplicate} Permit ---------------------------------------------------- This Permit Expires 1 Year From Date Issued Date Issued_7'! 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/LO AT10N_..I;q.9: '1_.____ _.'---.:- - �' ___ # -- ----�.- - - CENSUS TRACT._-._-- ----- Owner's Name. ._ hr�C1 �' "r _p�,�xlz�_ - Phone- Owner - l ------- ne-- Address-------- --------- 7 City c — -------- ZiP------------------------- ---- 7 Contractor's ---- -----°---- Contractor's Name-_:_.___ �1 � :w ��f --tL�t -,o-,License # Phone___________________ --- Installation will serve: Residence Apartment House ❑ Commercial ❑ ,Trailer Court ❑ 4 "t•-Motel ❑- Other---:-.------------------------- -- --------- Number,of living units:.---- --------Number of bedrooms._ '__,_Garbage Grinder_._'.___..Lot Size_____��'._: Water Supply: Public System and name . - :- - :.: .- - Private ❑ 4 ------ - -------------- Character of soil to a depth of 3 feet: Sand ❑ Silt[] Clay ❑ ; Peat❑ Sandy Loam [Clay Loam ❑ t Nerd an 'Ad6be ❑ Fill Ma'terial____ If yes, type____ ______ c p ❑ - k (Plot plan, showing size of lot, location of.system in relation to wells, buildings,'etc.must be placed on reverse-side.) NEW INSTALLATION: ` '4 e. ' [No:septic tank"or seepjge ipit permitted if public sewer is available within 200 feet,) CKAGE TREATMENT � 12.! S'.--- . r _ [..� SEPTIC TANK Size X '�� - [ Liquid Depth 3 Capacity,.' 0. -- -,Type 2------- -- - Material_ e, ____'_No. Compartments..---- - r Distance to.nearest: Well_ ---- =-� - Foundation b --Prop. Line-- -- -------------------- 1 a - Total Length r LEACHING LINE: [ No. of LiInes,:_.___��______ _: ,=• _ , _:.tength of each line._-_?,_ _ __---- I _ 'D' Box ---I----Type Filter Material__. - Depth Filter Material--:_ 7_!' _ -------------------------------------�" - ,... e __._,. _ 1 Distance.to nearest: Well -- __._-Foundation ------- _o ---------- Proper, Line... :.. L . SEEPAGE PIT'; [ ] Depth -----------Diameiteri___J... ------Number---=--------___--: R Filled -YeN Number--- s ❑ o [ Water Table-0epth ----------. -.Rock Size----- -=------`------=------ ------ Distance'ta nearesf:Well ----------- ------ ------ ------ Foundation -------------- - ` .Prop. Line--------------- REPAIR/ADDITION [Prev. Sanitation Permit# ---------------------- __:Date - V Septic Tank (Specify.Requirements)__. •_ ` ----- ----------=---=------------- Disposal Field (Specify Requirements)----- _- --------- = ------------- ----"--------- ------------- -- - d --------------- ......------- - ----- I :------- -_-.-- ---------- ---------=------ -----------•- ---------------=------------=-------- -- =--------- .i Draw existin and're uired'addition on reverse side t I hereby certify that,l •haveprepared this'app!ication and that the work will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of_ the. Sari Joaquin Local Health District. Home owner or licensed agents signature certifies the foIla'win" _ x "I certify that in the perforrnanc f the work far."which this permit 'm issued,-)-shall not p ner as Signed--------'------- -------•-- -- 7---.---- California.". v..;.. . VS2 to become subject to .Workman s Compensation> laws of Owner Y B ----- • ----------`------'--- - - � � it a cam, ' r i 'r I ,�� - ,l.0 1. 131979 (If other than--owner) t, .1 OR'DEPARTMENT'LISE ONLY: _ _._'SAN-JOAOUINLOCAL APPLICATION ACCEPTED: BY--------- ..__ - i =------------ ----- ------------------------ ---- _. ---- ----- - ---- DIVISION OF LAND NUMBER.___-s _ _ ----- DATE. ADDITIONAL COMMENTS----------------- ---- -_-- --- ---------------- ------------------------ :. ----------------------------I-------, --- - ------------------- -------- --___3__________________________...__-_____ - -------------------- . -Final drispection bY: _ "`----------Date = EH 13 24- SAN JOAQUIN LOCAL HEALTH DISTRICT Fes 21677 REV. 7176 31A