SU0005628 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: FOR OFFICE USE: ----------------------------------------------- -------------------------- -- - -- -- - ---- ./APPLICATION FOR SANITATION PERMIT ./ (Complete in Triplicate) - Permit No. �_lp--'S Date Issued_.`G�'�r..y ... . ..............._.-.-...-...._......_.....--__. .._. 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. 549andexisting Rules and Regulations: JOB ADDRESS/LOCAT� O //__.4_ -�-__,_ - Z-79. CENSUS TRACT. r .. Owner's Name -.. -`�OlDly- - - ------------ ------ -------- -- .-Phone__ JV6_7 Address..._---------+-�`---/ic---- - -- . .... ..�--�- - --. City- .----------....Zip.- --n--`-�----------- Conirador's Name.----- .. _.. .._(/L��/C. _ r.___-License #. 7+ �-._Phone.�f�/__SF33. Installation will serve: Residence Apartment House❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ------- ----- ----- ---------------- Number ------- ---- Number of living units:--,/--- ..-.Number of bedrooms---��/..Garbage Grinder-------Lot Size.... _ Water Supply: Public System and name---------'---------------------------------------------------------------------------- ----------------------------..Private C[�... Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat❑ Sandy Loam Clay Loam ❑ Hardpan ❑ Adobe ❑ 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.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) y /1 PACKAGE TREATMENT [ I SEPTIC TANK [� �J �Size_...1�>'X-577J I d/4ZLO`7.-_--.._Liquid Depth._J�S------------m Capacity 1640-----Type.- .01RL __ --Material.401t1....---------No. Compartments- -------21------.)7'---------\ Distance to nearest: Well------ S/------------------___Foundation_l5-"_ Prop. Line- ad LEACHING LINE [.. No. of Lines--------�--------------_ Length of each line..-----Z_-0 -Total Length __o! 0 D' Box_A�y.Type Filter MateriaLl.,!rIs Depth Filter Material...--.�-.--_..------------ Distance to nearest: Well-..-..7-IT......_.Founda 'on_.` ----_-.-.-.Property Line-----�-�7---- .._...... 01 axfax �o/ $EEPf�E-PIT ['r Depth-/' .......Wmwaw/nt__-..__......Number.__. ._..-.3-.-..__....j Rock Filled Yes I No Water Table Depth.---4� �1 -61 --' Rock Size ,�'� bus ,x ------------//�� Distance to nearest: Well__-1—6 � -5�. p. �jpi_/_.-___--� ..__-._._.___-.Foundation__ .....-..... . _.._.Pro Line-- .. REPAIR/ADDITION (Prev. Sanitation Permit#_____-----_----_---------------------------Date-----__------ - ----------- �,) ' Nq Septic Tank (Specify Requirements)...._.-....--..............._-----------------------------------------------'FILE -. Disposal Field (Specify RequirementsL-:-- ---- --------------- ------------ -..-.......-------. ---------- -------------- -------- ------------ --------- -------- -------- --------- -------- -----------*- ----------------- (Draw -----(Draw existing and required addition on reverse'side) I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Co. Ordinances, State- Laws, and Rules and Regulations of the San Joaquin Local Health District, Homeowner or licensed ager. 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 Work n's Compensation laws of California." - - - >+` Signed.., A _- - -_--. _-.._... _._.Owner�] u � By--- �f - --- _. ...Title 406 (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- - ------I- - - --- -- - ------------------------------------DATE.- ----- -'�- - -- -- DIVISION OF LAND NUMBER ------------------- - - - - ---- --- ------- ---- ---- --- -------- .,D*TE------ - -- ----- - ------- - - - ADDITIONAL COMMENTS........... - -- --- -------- - -------------------------- - -- -- -- -- -------------- ---- ------------- --- -- -- ------_--- .._... -------------.. - / - -- ---- - -------------- --------- -- --- --- Jj- ---Date--- -- - - ---- ---�- - -Final Inspection bY'--- --- eN -- ----- 13 Z' SAN JOAQUIN LOCAL HEALTH DISTRICT Fes 21677 Rev.7/76 3M