79-15 - Laserfiche WebLink

Home Browse Search

r .FQR,.OFFICE USE: APPLICATION FOR SANITATION PERMIT FOR OFFICE USE: -------------------- ----------------------------- - - Permit No./7-1_6: _ �. {Complete in Triplicate) ------ Date Issued_/-._=3_-_7_f --•••---------------------------------------------------- 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 and Regulations: JOB ADDRESS/LOCATION 1 R ---=------------------------------- -----CENSUS TRACT----------- ---------- Owner's Name-.- -EEo --------Ph ------ Address-------------------- ---------- City-'a.f_h�`."�C"'en ------------Zip------------------------- Contractor's Name-----A_e - - U.Z-Z �.. ----- ------License # 1 J- --Phone: . Installation will serve: Residence Apartment House E] Commercial E] ~Trailer Court ❑ Motel ❑ Other-----------------------------___ ______ ______ Number of living units:___ ___�__-.N.u.mber_of bedrooms Garbage-Grinder--_____-__---Lot.Size.__Z�17 _1x_/4 ? ------------------------- 4 Water Supply: Public System and name' - -- ---- ---------------------------------- —F- Private ❑ -- P th of 3 feet: Sand ❑ Silt ❑ Clay ❑ Peat ❑ (Sandy Loam Clay Loam ❑ Hardpan ❑ Adobe.0 Fill Material._.__~_ _ If yes, type_________ ____________------ Character o sol to a de (Plot plan, showing size of lot, location of syst m`in rel at+on-to.welr;,buifcl:ings, etc.,mrst be placed on reverse side.) NEW INSTALLATION: {No es ptic }ank or seepage pit permitted if public sewer is ailable within200 feet,) PACKAGE TREATMENT ; ] SEPTIC TANK [ ,] Size---.-- ----- �_____ _ Liquid Depth--------------------------- --- Capacity --- ----- ---Type= --------,-;-� terial'�""""r7'7."'N Compartments---- ---------------- --- It, Distance.to nearest: Weil.J__.-•._---------------------�-------Foundation----------.-.-------- 1_-.Prop. Line--.----------------- --- - -- ~ _ _; � -. LEACHING LINE [ ] No.€of Lines___-_---.;.,_,_ _ -----Length of each-Line, ______________________Total Length.,-.------.,,,-._._.________.____------ ' 1 t } - �D' Box_.:---4--Type Filter Material_ �____ .___-_Depth Filter Material____ __________�------------------------------------------------ Disfanceto,nearest: Wel!-''-------------------------Foundation--------.--------------_-. -Property Line------------------------------ -_-. SEEPAGE PI I -.; 'u T [ ] Depth'.--.----�s -Diameter.-------------------Number-------------------------------- { Rock Filled .Yes ❑ No ❑ ' . k iWater Tab Depth.--------;-- =---------------------------'------=---.Rock Size---------------------i-------------------------- Distance to;n Barest: ell-- ---------------------------- ------Foundation--=-------------------j--.Prop. Line-----------------------•r-- REPAIR/ADDITION (Prev.'Sanitation her m t#---------� ------------------------------ Septic j _______ �-----�- -----�----•-------------------Date-----; -- =--------- --) Septic Tank (Specify'Requiresnentsl -------- _�J '-=-- :-------------------- ----- - --------------------------------------- D ------------------------------------- Disposal Field {Specify Requirements)_,- 1 _�,.&✓�---------_ x--- // -- .- 5--- - ---- --------------------_---, lr - --------------------------------------- ----------------- -------------- -- _------- - --- ________________________________________________________________- -------------------------------------------------------------------- _ } _ __ -----_----___---_________ I hereby certify that I have prepared this p cation and that the work will be done in accordance with San : (Draw existing and required addition on reverse side) I Joaquin County Ordinances, State Laws; and Rifles and Regulations of the San Joaquin Local Health District: Home owner or licensed agentR � 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 o mans Compensation.,.laws—of_California." Signed----�<. --------------Owner By- 1 = Title } (If other t an owner) i . . — ,-"FOR-DEPARTMENT`USE-ONLY .""'—" - APPLICATION ACCEPTED BY..............-G4 ¢"- 1. -:- _ ---DATE.---lZ. ---- -------------- DIVISION OF LAND NUMBER----------------- ` A' - =---DATE---------------------- ------=------ -------t ADDITIONAL COMMENTS------------=------------------------ ------------------------------------------ - ----------------------------------------------------- --- ---- ------------ ------------------- ---------------------------------------------------------------- -- --------- --- Final Inspection by:----- ":---------- - ------------- ------------------------------------------------- Date- � ZQ EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&s 21677 REV. 7/76 3M