78-297 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: FOR OFFiCEPUSE: APPLIC" ATfOiN F�SANT�'C�RMIT -------------------------- --- ------------------------ {Complete in Triplicate) Permit ---------------------------- ---- --- --- ------- ---- Date Issued-"-S--.""3 7-" Y"_.""k _________________________________________________________ This Permit Expires 1 Year From bate Issued Application is hereby made to the San Joaquin Local Health-District for a permit to construct and install the work herein described. I This application is made in compliance with Coun r 'Hance No.1549 and existing Rules and Regulations: JOB ADDRESS/LOCATION-------- - .- ------- -------CENSUS TRACT------."-- --.--- Owner's Name --------- --- -- z -'------ - ---- ------Phone - r - - . Address -� � � -- 011FCitYZiP " Contractors Name"-- �'i.r¢ Gf}!19f �-- 'StP �'3ts _- _�' .__L'� _____License #-_��0312.-----.-Phone_t,/—/ .6 Installation will serve: Residence Apartment House.❑ Commercial ❑ Trailer Court ❑ a Motel ❑ Other----------------------------- ----- ------- Nu mber - --Number of living units:-_-,-----------Number of bedrooms__.-L.�-----Garbage Grinder------------Lot Size--30s,-3_f Water Supply: Public System and name------ ---- ---- ------------------------- ---- ---------------------- -------- Private Character of soil to a depth of 3 feet: Sand ❑ Silt ❑ Clay ❑ Peat D Sandy Loam ❑ Clay Loam ❑ Hcirdpan ❑ AdobelZ 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,] PACKAGE TREATMENT [ ] SEPTIC TANK �J _- Size-__- ®Q__'_"-- :-- ---------------------Liquid Depth J'R-------------------- E _ Capacity /4---1-19-----,TYPe -- ------------- Material-----------=-------------No. Compartments------�.- -----------------------kA Distance to nearest: Well -------------------Foundation----J.®-----------------Prop. Line.------------- ------ +L�( LEACHING LINE 4(J No. of Lines----------- ---------------tength of each line.------_ .�� ---"Total Length -__ �'¢_-� i i 'D' Box-_. --Type Filter Material'_fa_k----Depth Filter Material----r-p_---_------------------------------------------- _ Distance to nearest: Well---- d?a'__`_________` -.� Foundation--.' -------------- -Property Line---- O r SEEPAGE PIT [ ] Depth----------------Diameter-"�+ .----------N mmi'er--------------------------------- Rock Filled Yes E,] No Water Table Depth.------------------ =. s -------------------- --Rock Size---------------------.----------------------- I r Distance to nearest: Well---------'--- ------------- ------Foundation-------...------........ Prop. Line------------ ------ REPAIR/ADDITION {Prev. Sanitation Permit#-------- `= -------------------I--- ----------Date----------------------------- - - N. i Septic Tank {Specify Requirements):..-10-0-4'---jld 4-1-------------- - Disposal Field.(Specify Requirements) _-GG - G/�s-E S__-! O:- -- ' ---- ______---�.__ ------------ "--------- -- -------------- ` = = ; -1--- v.• .---------- - ---*- `- - _----fi---- - ------ ------------------Z------- --- --- --- ---------- i (Draw existing and required addition on reverse side[ I hereby certify that I Dave 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 Son Joaquin Local Health District. Homeowner or licensed agents,j 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 bec e s [ect to Work 1 mpensation laws of California.: SignedOwner -- --------------------' --------- - , --:.Title.-"_-- (If other than .owne.r� ' FO&PEPARIMEJISIT USE APPLICATION ACCEPTED BY - =------:-,-.-DATE -----'----------- s: - DIVISION OF LAND NUMBER _--..-- = • ------- DATE. ----------------------- --------- ADDITIQNALCOMMENTS - '---------------------------------------------------------------------- r------------------=----------------------------'- ---------1=---------- -_ s ---------m--------�-.-----~--------'-j- --�------ -------------------- -- ----------------------------------------------•---- -- ------------- ------- ----- ----------- -- ---------------------------- -------------------- ------------------------------------------------ ... - - ------------------ --- ----- ------ - -- �Final Inspection by: -----Date- --- EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT las 21677 REV. 7»6 31A