78-990 - Laserfiche WebLink

Home Browse Search

F ✓ FOR OFFICE USE: OR OFFICE USE: APPLICATION FOR SANITATION PERMIT ---------3------------------ ----- Permit No.-7r7Y '? (Complete in Triplicate) ----------------------------- ----- ------- Da#e Issued-x�-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: - n [� _CENSUS TRACT_.Y._--"-.. JOB ADDRESS/LOC . ION__ `Y-,--- - --- --- -•__:_ / " '"' Owner's Name_ -------- '. �Pho�ne C r-C�S G G:� Address- ��, ---- --- ---- - : ------------------------ -- City 't. ZiP :v'"J _ ",_ Contractor's Name = --------------- ---- `License #_�O a -/_ ne. ---'�3--- Installation will serve: Residence (Apartment House❑ Commercial ❑ Trailer Court ❑ { _.. .;...Motel ❑ Other:_=='-----' 1_...___._ t._.____ .___..__. .,_ /.' ff rr// J Qum a Number-of living units:---_ ------------Number-of bedrooms__--7-__-Garbage.Gr-inde�r__1_x Lot .Size.-- _�_____________-------------------------------------- I """"._-_ .--- '_-----------------. ' .r Water Supply: Public System-and name------..---- --- - --------- Private [ Chpracter of soil to a depth of 3 feet: Sand h :Silt❑ 'Clay�- Peat ❑ j.Say Loam E] Clay Loam ❑ F } Hardpan ❑' "Adobe ❑ Fill Material'.7, _Ai yes,.ty�e __ -JA - (Plot plan, showing size of lot, location of sys#tem in relation to wells, buildings, etc;must'be placed on reverse side.) NEW INSTALLATION. (N6 septic tank or eepage :pit permitted if p bli�csips ov'ai able within 200 feet,) / f , PACKAGE TREATMENT '[ I- SEPTIC TANK (b.}� Si e� l ._XCo""1�: 0_ ___-_ ------------Liquid Depth.: t Capoci'ty_/_ _04__'_TYPe-= f I Material-_/L0 �- _-=_No. Compartments-------�--------=------------ -, � !d _.Distance to nearest:.1N'ell__41__�� -- loun lation a -"-.__�______________Prop. bine"-"��"f_""".- --". LEACHING LINE. No. of Lines.`_ "-"--- J`•-•,,,•Leri�th;of•ea { Total Len th _ Y'•1 J gg d [ g in :.., hIl e." l v " - f tic �k ` g :E - .._ yP ;" - 2Depth Filter Material •' Distance to nearest: Wei l-:-1�--__ s„ t ,� $ , nal _ ----- �-=- -�-�-----Foundation- ---- ----- - ---..,Property Line : '-------------------'--------- D'YBox _._ T e-Fi ter Ma#s" fid .,�►� ".�fi ... .. SEEPAGE PIT [ Depth_4v.P_ ---__.Diameter_:y!--------lNumber-__`_--______________ ___ _ Rock Filled Yes No ❑ 4. Water Table Depth-"-:". ` c 1Z " O = " ------------------- Ro e� f � - M ------- � Distance to neares#: W611 ----- " "_ Prop Line_._"""- --- "Foundation__.-" REPAIR/ADDITION-{Preva Sanitation Permit#-----:.__":: - :_-----------:Date----- ----------------------------------------1 - 7 Septic Tank (Specify.Requirements)-------------------------- - --- -------------------------,-------- ----- Disposal --Disposal Field (Specify Requirements).-=-......------------- ------------------ --- ---- --------------------------------------- ---- ;---------------------,--------------------------- - -- ------------------------------------ - -- - ---------- --------- - -.:.- - :.: E ----------------------------W -----------------------------------------------------------------.---- --------------------------------- =----- _ ' ------ v ------------------ 7- •(Draw-existing-an 'r`"equired`ad ition`on reverse side) J I hereby certify that'I -have prepared this application and that'the•work will be done-in -a'ccordance 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 become-subject to _Workman's Compensation laws of California." Signed - = I' ---- ------- ---- -------- -----------------------. Owner I BY j - �! ---- . itle---- 11 '� C`. -- - - - ------------_ -_---- - - •T (If other than owner( V Co; .... �. ; •_• � FOR:DEPARTMENT USE ONLY'- r APPLICATION ACCEPTED BY.- = 0 - - --- - --- DATE �� - DIVISION OF LAND NUMBER: ------------= -----= DATE._ - F ' : ' :. ADDITIONALCOMMENTS------------------------- ------- - ------=-------------------:- ---------------------------------------- ---- # - ------------------ --- --------------- ---------------- 4 1I 1 F - -------l� Date__ -- --- Final Inspection by:.-- = " ----- = F&5 21677 REV. 7/76 3M - EH 13 24 SAN JOAQUIN CAL HEALTH DISTRICT