77-1002 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ---------------------- ----------------- --------------- Permit No. 77�_ UU� (Complete in Triplicate) . Date ate Issued�_�._._i-3 _. -------------------------------- -------------------- This Permit Expires 1 Yedr From'Datr±e Issued Application is hereby made to the San Joaquin Local Health District for a pe mi o construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing.Rules and Regulations: 05'3..:- 0 5'3 _ JOB A RESS/LOC T ON6 -- 1 t'.-� � -- CENSUS-T ACT.-.�:6 -_-. Owner's Name- ----------- --------------------------- ---- ------ Phone m Address----- 7 - - --- tyle'-/-`` -F— -------------- P- -�`�` C� zi 7 Contractor's Name-10---- :- ---------------------------------LicenseL#._.3 7_ --------Phone--�6�-___-_ ------_ r Installation will serve: ` Residence ❑I Apartmen House Com ercia E] �" railer Court ❑ t . a ..i •.Motel ❑ Other .: x. e Numlae'r of living units:_.__ -__-Number..of.bedrooms-__ _._Garbage Grinder_. ' _-__[-Lot,.Size:- >. '._-------- --- -- ----_-.. Water Supply: Public System:and name----------- ,'------------- ---[ ! - --_--1_-- Privateer Character of soil to a depth of 3'feet: Sand ❑ Silt Q Clay ❑ . Peat❑ Sandy Loam ❑.Clay Loam Ems-� ._. fk Hardpan ❑ Adobe.❑ Fill Material--------------If Yes, type---!-------------__1\------ (Plot plan, showing size of lot, location of system in relation toywells, buildings,:etc.1must be:placed on reverse side.) NEW INSTALLATION: (No-septic' tank`or see' a e it '` with t r -, ee . pF p g p permitted if public sewer is available within.20D�feet,)�,. I PACKAGE TREATMENT - "r' [ Size--'Sri r / [ I SEPTIC TANK--'[ lv .Z Li u`' iDepth --- "-`% v /,20c r A1C � ,� Capacity / Type -Material ([r�r3 - ^.No. Compartments:=.-Z Distance to nearest: Well -------------------------- - _Prop. Line_-._� -----------___ Foundation.__ LEACHING LINE [�}!No. of Lines. .; --------------_._-.Len �th of each line-.____ _� g �� g -.-.._..._. Total Length. y D' Box_/'_.Type Filter Material__ __Depth Filter Material__________.__ .____ -:T -_ _ ----------------- Distance to nearest: Well-:._,";, __-___.._Foundation_.- `� r Pro perr' Lin e_. P -�4 SEEPAGE PIT - �___--Number-------- ----------------------- � �� Rock Filled ' Yes �No [- De th -.=.-- Diameter-:--- ---- s Water Table Depth--------IAO-------------------------------------- Rock Size--` ' Distbnce to nearest: Well-- --��-4 /- ---- Foundation---- `----- Pro ---- �� -- = Prop. Line. 1 REPAIR/ADDITION (Prev. Sanitation Permit-#----------- ----------------------------- _____- ___:_ ' ._- - ------- . _." ter- ---------------- eptic Tank Requirements)- --------=-- ------- Disposal FeldISPecl YRe uirements). - --- -------------- -- } - -----=---------------------=----------------:----------- -------- -- = ------------------- -------------=------=--- -- ------- --- (Draw existin and required addition'on reverse side) I hereby certify that.1 hove prepared 'this:application and that the work will be -done in accordance with San Joaquin Coln Ordinances, State Laws; and Rules:and Regulations oftheSan Joaquin_ Local Health District, Home owner or licensed ager 1 signature certifies the following: , "I certifythat in the � , i performari�e of_fhe .work for which this permit is issued, I shall not employ any person in such manner a to become subject to Workman's Compensation laws of California..' ' `" lgned- = - - ------- ---- = -=------------Owner s r/ ---- -"` -- - --------=------ - Title. 1f.. . (If'other than`.owner) 17 "FOR DEPARTMENT USE ONLY'' APPLICATION ACCEPTED BY -` --- ------'----- --------------- ---- ---------- DATE 12.- = 7 ) DIVISION OF LAND NUMBER:, = =-------- --- - - --- - "------: ----'-:-- ----------"----DATE- ------------->---=-- ---------- � ADDITIONALCOMMENTS -- -------=--------------------`------'- -----=-------- -----------_------------------ --------------------------- ---------------------- -------------------------------------- --------- -------------------- -------------------------------- -- ------ - --- ------ -------.--------------------------------:------------------------------ ---------------- 3----------------------- - ---------- ---------------- - - Final Ins ection bY:---=---- - -- ------------------Date- .f-- ----- - f EH 13 24 SAN JOAQUIN LOCAL HtALTH DISTRICT FLYS 21677 REV. 7/76 sM