78-1112 - Laserfiche WebLink

Home Browse Search

TOR OFFICE USE: FOR OFFICE USE } ` ------- --------- ---- ✓ APPLICATION FOR : - - -------- SANITATION PERMIT 4 (Complete in Triplicate) Permit No"_77_/// ;;1` 24 -------------------------------------------- --- This Permit Expires 1 Year From Date Issued Date Issued a-71./�-7 Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: described. JOB ADDRESS/LOCATION---.-I- _ UJ AVI --------- ------------ ��4 N feC/ ------- --CENSUS TRACT ---------------- Owner's Name------ 03-- -------- ---N�_T5©rq 2-3 _- C 1-37---'- Address---- ------- ------ ------- ......................... -------- -------- --------Phone-- - ------ --------- ------- __________��?� ------ -------------- -- ------- - ------- --------- ---------- --------- -city Ic (0%f e p Contractor's Name___ _ ___ __ -- -- - ------------------------------------License #--- - -31/�_9-------- Phone---- ----------�-9Y - Installation will serve: Residence X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other. Number of living units:------__--------Number of bedrooms___3__.__Garbage Grinder-----_------Lot Size-------�IWIWAC' /3 +' Water Supply: Public System and name___-_-____----------_ _ __ ---------- ------- -- - - ----- ---Private�J Character of soil to a depth of 3 feet: Sand • .Silt El Clay, ] Peat E]Peat Loam ❑ Clay Loam❑ Hardpan ❑ Adobe'❑ ' Fill Mater ai_...______-_Jf yes, type LA (Plot plan, showing size of lot, location of system ii,re'ation to wells, buildings, etc. must be placed on reverse side.) eepa NEW INSTALLATION, (No septic tank or sge pitpermitted if public sewer is available within 200 feet,] PACKAGE TREATMENT ] ] SEPTIC TANK [-] Size_.___X-- - y 1/-- - --- -- -------- --------- -------- Liquld Depth----------------------- Capacity__/60P-_---__Type.-P '6� _Material_._�n1Qw ---__No. Compartments---------2----------- ----------- Distance to nearest: Well-_____ o-_ --_ - _- _------ Foundation__t_1 1 � 4 --------------Prop. Line. LEACHING LINE [ ] No. of Lines-____.� I _--_ --- Length of each line_____ioc> /(7isr --------------.Total Length.----------- - _ - --------------------- yp Iter Maternal-__�_}/:z-C-";.Depth Filter Material_.____ D' Box--- ---- -T e Filter --�- ----- -- ------- Distance•to nearest: Well _____/Q0I------------Foundation---__-/-0-�___ Property Line----- -----------------------SEEPAGE PIT [ ] Depth -.Diameter----- -------- --- Number Rock Filled Yes [I No EJ Water Table Depth---i---------------------------------- ------------------Rock Size- ---------------- ...................... Distance to nearest: W611- - Foundation__________________ --------- ---- - -------.Prop. Line---- ------- ----------- EPAIR/ADDITION (Prev. Sanitation Permit#___ -----------------------------------------------Date-- ------------------------------------------} eptic Tank (Specify Requirements)__________________ - ------------------------------------------ ----------------------------- isposal Field (Specify Requirements)--------------- ------ ----------------------------------------_____------------------------------_-------------------------------.------------ raw existing and required addition on reverse side) r 1 hereby certify that 1 have prepared this application and that the work will be done in accordance 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----- -- - - ---p---- Owner By--------- --- R - - --- ---- - -------------------Title------ --------- --------------- if ot er than owner) - FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------ DIVISION _.__...___ -- ---------------------------------------------------- -------DATE.--IVISION OF LAND NUMBER_________________ --------------- -- ---------------DATE------------- --------------- --------------------------- ITIONAL COMMENTS- --- ------ - -------- - - - .......... ------- -------------------------------------------------------------------------------------------- --------- ---------Z------- Final Inspection by__________ ___ _ �_� 7 - -------------------------------------- Date --------- -------- --------------------EH - i3 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&S 21677 REV. 7/76 3M r`"7Z