77-208 (2) - Laserfiche WebLink

Home Browse Search

APPLICATION f:'Oili SANITATION PEP-MIT R ....... (Complete in Triplicate) Permit No. r ... .. :. �,. This Permit Expires 1 Year from Date Issued' Date ( � Application is hereby made to the San Joaquin Local Health District for a permit to construct and Inst described. This application is made in compliant ith County Ordinance No. 549 and existing Rules alnd Regulations.l. the rrein JOB ADDRESS/LO N / .. { - ................. Owner's Name . CENSUS TRACT ! CT . .- - �,J�.V.�.1 Address . .. .......rpp�® .- D .,......Phone �� 9� ------ ..........CIty �_- Contractor's Name ti -............... . F ---.,,pc<�-.•��4R .._.License . ...,-. .... , 5�: .. Phone �dp� installation will serve: Residence Apartment House 0 Commercial ❑Trailer Court �. Motel ❑other..._.-••-..... r .. Number -"'•" of living units:... Number of be # ' ••-----• Brooms ..�-Garbage Grinder". _ Lot Size f Water Su .�.... pAIY Public System and name ___.-----=-- Chdracter of soil toad .............................. ..... r P ivate, depth of 3 feet: Sand b Silt d Clay r❑-' peat❑ Sandy Loam o Clay Loam Hardpan 0 Adobe Fill Material If yes,type...... Mot pian, showing size of lot, location of system in relation to wells, buildings, etc, must be placed on reverse sid NEW INSTALLATION: (No septic tank or seepage pit permitted If p�,bl#c sewer is available within 200 feet,l PACKAGE TREATMENT f ] SEPTIC TA �Q e. .__'.....__ .. .. Liquid..Depth . ��.. Ca aci Z --_._._ . P ty -. iW Type IZ.2!7-A�aterldl !le r~ No. Comp Distance. to nearest: Well Compartments .................Foundation ..... Q i e s ... LEACHING LINE i .... No. of Lines -.. . Prop. Line Length # ea lmeD- e �... .. .. � ,.,� Total Lang ' D Box• '' . � ... Length Type Filter Material Depth Filter Material .... �r i 16,........ ;. Distance to nearest; Well ...... ... Fo ndation SEEP.,... AG PIT ' Depth / ., ®: Property Line �° Diameter ...... Number ------ .Number - .-----r.. ..... Rock Filled YesNo �] Water Table Depth _..(�, Rock Size . .. . .,� " Distance to nearest: Well ... . ....�J._•----•._•. ----••Foundation�%7 - Prop. Line ....�.. REPAIR/ADDITION#Frau. SanitatSon Permit# _.-----......... I = ._...-- Date : Septic Tank (Specify Requirements). _.-:-------- ...... . --- } .......... ...•• ements1 ...Disposal Field (Specify Re uir ....................................................... --•------••-----•--•--•-- - •.................... . --------------- .a y • ,.. - - Y .......^ ......................_-......_..�...................... (Draw existingand required addition on reverse s idel -� . �.. _. 1 I hereby certify that I have prepared this application and that the work will bedone In accordance with San Joaquin County Ordinances, State Laws, and'Iuies and Regulations of the San Joaquin Local`Hatilth.Diatrict. Horne owner or licerw i sed agents signature certifies the following: "I certify that in the performance of the work for'which this permit ii`issued I shall not ern to an as to becan}gsv etf Warkman's Com nsation laws of California.' employ y-Parson in such manner Signed _.--•- - ---t. . -,-. •��1�'.f:�'f�.-.`+�'.... .m r•1..5.. � rn! ----- --- --- GWMWF BY -- - s (if other than owned J•itle ....................... FOR DEPARTMENT USE ONLY +- APPLICATION ACCEPTE© BY--- ---- - '-' BUi.LDING PERMIT'15SflED ------------- ---.---- _-�-- ---- - �- . _ . ,,.._..- PATE ...1-.... -. ADDITIONAL COMMENTS ....... . . . . ... . .. .... � DATE':..,. i --------------------------..- •--------- ---.---- -- .---....'. ... ..... .......... -- - .... Final inspection b ---- -- --• ... - .-----•------------ - - � I EH 13.2h 1-fit3 �� , .......Date .. ....... ... .. ... . SAN JOA iN LOCAL HEALTH DISTRICT 8/7 h 3Mr