78-813 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: J/ FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -------------------------- ------------------------ Permit No.7F-9Vj--- (Complete in Triplicate) Q --------------------- Date issued-_1-": 2,9 --------------------------------------------------------- This Permit Expires I 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 madefin�c-omplliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION-----. " .;.�cucz t 2-to Q0 __ -_ �7J:_ 1"_.CENSUS TRACT . --4_ 755-c rLOrz! Owner's Name %_Ckaf di - - one_ " -237 Address-------6-(06-) V A).m6n - = Ci � G�{:(:0� P ��J Contractor's Name.--------- � = ---------- -- ------------------ ----------- ---------- -----------------License #------------ ---------------Phone-------------------- ------ Installation will serve: R�esi ence ❑ Apartment House.❑ Commercial Trailer Court ,. ,. Motel ❑ Other--- -------- ----- � " Number of living units-----------------Number of,bedrooms_,------ Garbage-Grinder..-.--------Lot Size__.----------------------,...____,.._------------------- Water Supply, Public System and name--------------------------- ---- -------------=-.---------------------------- - Private ❑ - i Character of soil to a depth;of 3 feet: Sand ❑ Silt ❑ Cloy ❑ Peau' Sandy Loam ❑ Clay Loam ❑ Hardpan E] -rAdobe ❑ : Fill Material..... ----If yes, type--------------------------- � (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.[ N NEW INSTALLATION i-(No septic t&IC'or seepage pit permitted if public sewer is available within 200 feet,] r �� 9 PACKAGE TREATMENT [ ] ; SEPTIC TANK [ ] Size------------ ,�7C�--------------------------------Liquid Depth__I7_q-.---------------- , Capacity--------------------Type-------------------'---Material---------------------------No. Compartments---2-------------------------- -- Distance to nearest: Well.-1.ZQ_0---------_,-.____._.._ ---Foundation.-10. ------ -------- Line.2. $_O--------------- i 04 1 LEACHING LINE. [ ]. No. of Lines-"---------- Length of each line. 06 - ------- ----.Total Length -f� - ------ ------- -----------"- p'D' Box-- -------Tye Filter Material--------------------Depth Filter Material-----------------------------------------------------------_ Distance --. t { to nearest: Well----------------------------Foundation---_- ---------------------Property Line----------------:---_------------_-.r SEEPAGE PIT [ ] t Depth---------- ----Diameter-------- -____------Number-------------------------------- Rock Filled Yes ❑ . No ❑ i Water Table Depth-------------=------------------------------------- --- Rock Size------------------------------------------------ Distance to nearest, Well-------------`--------'--------------------Foundation----------------.----------Prop. Line----------- REPAIR/ADDITION (Prev. Sanitation Permit#""""""""._.-_"-_-___--____-F------------- -----Date--- ---------------------------------:...... Septic Tank (Specify Requirements)---- - --- ---- ---- ---------- -------------- "° Disposal Field (Specify Requirements)--------------------- ------ ----- --- 'f --- ----------------------------------------- ----- -------------------------------------- -------------------- -------------------- ---------------------------------------- (Draw existin g and required addi tion 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-i-A 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 ------------ Owner ) Byl------------- _1>�rY1 Title ,(� 'FT _.. } (If other than owner) FOR DEPARTMENT USE ONLY ��PPLICATION ACCEPTED BY� �"�"-- - - - -- ---- ----------------------------- - - - - --DATE_- �.� -? ------------------------- -Y -'`tiIVISION OF LANA NUMBER- --- ----------------- - -- - - � � �--------- ------------.BATE --------- ---- --- -- ----- _ AQDfTIONALCOMMENTS- ---- --- ---- ---- - -- - - -�---------------------------- ----- ---------------------------------- ----------------------------------------- ---- ------------------------------------------------------------- ------------------------------------------- -------%----------------------------------------------------------------------------------- - ------:----------------------------------- ------ ------ --- ` --------------------------------------------------w-a----------------------------- _ Final Inspection by---------- -- - - ----------- -------------------------- Date EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&5 21677 REV. 7/76 3m