79-423 - Laserfiche WebLink

Home Browse Search

FOR OFFICE US - FOR OFFICE USE: Permit APPLICATION FOR SANITATION PERMIT No. :- V-.6 ------------------------------ (Complete in Triplicate) ry -- ! Sr�� Date Issued...... ........ _--••--------- -----__------..-- This Permit Expires 1 Year From Date Issued ce No. 549 and existing i Application is hereby made to-the San Joaquin Local Health District fora permit to construct ules and Regulations: work herein described. This .application is made in complionce.with County Ordinance � g Y �• ---- CENSUS TRACT...............-- ------ -.---- JOS ADDRESS/LOCATION---------- Le �?�tt1 Phone...: ------ - ---- ..... Owner's Name......- ---- --- -------- ....-- - U it1 td7 City;.. � p- .......... = ' ... fel t-fi Address-..-..�- - l i .......... . ` - . ... . ._.:'- ----------- Contractor's Name---- -e �i� � f .........-•--------•.... ... ............. ........ =------•------ #. .- ..- ... Phone ❑ installation will serve: Residence [ Apartment House ❑ Commercial FI Trailer Court y j Motel ❑ Other_..., `...:=- 4__._----•---- ----: i i l r_-. � - --•--- ------ Number of living units:...--.�__-_-_-_-Number of bedrooms--_-�....Garbage Grindea___-_ Lot Size._--..., .- private [� ---- ---------- --- -- ----- `-----.:. -- Water Supply: Public System and name.... ---------:. ,,,e I Peat Sandy loam ❑°-f Clay Loam ❑ Character of soil to a depth of 3 feet: ` Sand ® Silt D Clay ❑ t r Hardpan F-) Adobe ❑ 1 ill Material.- ... _ . if yes, type--------•----- [Plot plan, showing size of lot, Iocati )cAfof system in relation to wells, buildings, etc. must be placed on reverse side.) i NEW INSTALLATION: (No septic tank'or seepage pit permitted if public sewer is�avollable within 200 feet,) [ SEPTIC TANK [ } Size._....�.1'� .�:-��'--k"°:-��---------- ----------L�qu�d Depth._-/�--- ------ PACKAGE TREATMENT [ ] g Capacity TypeRer�s ' ..Material-_._ �''�"` ---No. Compartments i � Pro Line---- Distance to nearest: Wall-- ---- ---- -- Foundation.----...;- P' 2101 --- ---.Total Len th -_ .. ---•----------- ------ ------- LEACHING LINE [ } No. of Lines. _._... --------------- Length of each line..:'`--- Cy-- g. 3 I .ZCq ,� D' 13ox----. .....Type Filter Material._-..... ......... Depth Filter MaterlaL_.--....- .. .--- r t to( o ------------ Pro Property Line------�--- ------ < � --.Foundation------------- Distance to nearest: Well------ --- ...... Rock Filled Yes ❑ No SEEPAGE PIT [ ] P ----------------------- Water Table Depthmeter----------- --. -w }----- --- --.Rock Size- _-.- _._.. - Distance to nearest: Well------------ ---- -- - ---- -------=------Foundation.---------._...- .-._..._-Prop. 1ne----..-------�-- - ---- . RE ., f ....- rte__ --------•Date..................... �------ --- ---�------} PAIR/ADDITION (Prev.(Prey. Sanitation Permit#---- -- -- Septic Tank (Specify Requirements)... .................. -- .................... ......y-;-------- ...e-- -------------- Disposal Field (Specify Requirements)------ =------------- -•------ -------- -3-----------y_ 1 1 ` __ ________.__ .. ._- _..-____ ___-. __--__...-...------------------------•-------•---.__-----.:.--__-..._.._..__.--..-..._------`----------------- _.....------ ----------- ______ ____ - - (Dr�aw existing and required addition an reverse side) lI hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County i Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District, Home owner or licensed agents k signature certifies the following: .,, "1 certify that in the performance` of the work for which this permit is issued, I shalt not employ any person in such manner ae to become subject to Workman's C pensatiort laws of California." Signed Owner -- -- --- -- .-.Title-- ------- ------ ------- ------------ -------- ----- ------- --- - ----------------------- - By........ k (if other 7tan owner) I OR PARTM T USE ONLY DATE 7 .-•-.._. APPLICATION ACCEPTED SY------------- - -- - --- --- _._.DAT ----- DIVISION OF LAND NUMB _-.-----.- ADDITIONAL COMMENTS----------------- -- ----------- ------ ---- .�f Date...- S..- Final 1n5peGYYan b - &s 21677 REV. 7/76. Y ( f EH-l3 24 SAN JOAQUIN LOCAL HEALTH DISTRICT