78-703 - Laserfiche WebLink

Home Browse Search

r FOR OFFICE USE: "'' FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT F --------------------------------------------------------- (Complete,in Triplicate) Permit No. ?_-7Q_3 ---------------------------------------------------- --- Date Issued-.Y?/.5'�%2_$' --------------------------------------------------------- This Permit Expires',1 .Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This applicatiori is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: �. .. . . . .. _.._. �. _'�.._.r T,.. ._.. _ �. _ JOB ADDRESS/LOCATION /O-f-9�-----h�---L+/ Yc��---------------------------- ------ ---- `------.CEN ---------- --------------- - CENSUS t Owner's Name........ - '-41_e-7r Y-'-----.._ .G1_T'_ -$..[1 e ---------•------- ------ ------------------ ------ - one-_%3s'---3 J�1I-y P ------------------------- Address... ��^ � - -- --- -- ---------- -------_City = Z.iP Contractor's Name.-- '__A�iTho� ------ ._.Soitl. License #_/��' .>E�6 Phone--S'.------ ---- i Installation will serve: Residence [,� Apartment House.❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other---.------- `` ------------------------ X, ` € 1 Number of living units:-.____l-------Number of bedrooms-_ -----Garbage Grinder__-.- --__Lot..Size_=.,.._ .=..,/Jc-Y s ----------- Supply: Public System and name_ ---- Private�] = F f -------- Character of soil to a depth of 3 feet: Sand ❑ Silt Ll Clay, ❑ Peat ❑ Sandy Loam 5d 'Clay Loam ❑ a Hard an � Adobe -""Fill Material--- Ifyes-type- (Plot es`t e_- ------- - -- ------------ " w _ p ❑ ❑ Y YPr (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) 3 *i NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,] E PACKAGE TREATMENT [ ] SEPTIC TANK . ICI . ..e Size-----------------------------------------------------------Liquid Depth..------------------------- E --- Capacity./!4410--- -- YP /�y� CMTMatwial -Cq�1C--------No. Compartments - i�G /b i :2p................rt Q 1 Distance`to nee'rest: Well------ Foundation-- `---- --Prop. Line---_-__-- a,�� LEACHING LINE [ ] No. of Lines--_-- -_3________________Length of each line fib_+____--________.Total Length._.___ '4'.-___.___._ __�; �, ] :'D' Box._ --/-----Type Filter Material _/?a A__- -Depth Filter Material------A,a------.---------------------------------------?__-- ,� Distance to nearest: Well--.------ 5,_._-- - Foundation.___-.--✓r--------------Property Line-.- ---------:..___-----_--�,__. SEEPAGE PIT [ ] Depth________________Diameter______ _ _._-___--_Number_______________._'_.-___________ Rock-Filled Yes ❑ No ❑ Water Table'Depth------------------ -------------------- ----- ------ --- Rock Size--- -------- ----' (t ------------------------- i ... sy ] Distance to nearest: Well--------------------------------- `----.Foundation------.---------.-----------Prop. Line--------------------------- REPAIR/ADDITION (Prev: Sanitation�Permit#-----------------------=--------------- Date------------------------- Septic Tank (Specify Requirements) ---- ---- ---------------------=-' `------- -------------------- ------- ----- DisposalField (Specify Requirements)---------------------- --'--------------------------------------------- --------------------------------------------- ---------------------------------- } (DrdW existing grid required addition"on reverse side) I 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-----. --�/.Y7X_ 7 So�Y ' Owner --::--- -.--- BYl-"--"-= l ----------- ------ -- -------------- --Title.--------_----- ------ -- Iof er than owner] } : 'FOR EPART NT USE ONLY j APPLICATION ACCEPTED•BY... .....--`---- - -----------= DATE-.------- l - -------------- DIVISION OF LAND NUMBER. -- ---- ---:-- -------- -- -------- DATE ADDITIONAL COMMENTS--------------------------------------- I-. _ r 1 ' --------------------- ------- ---------------- ---------------------- --- -------------------------- - -----_ - - ---------------------- ----------"-"---------------------------------------------------------------"r--"" Final Inspection - � ' - ---- - -- --------------------------- _--- --Date------------------------- ------------ - -- xi. EH 13 24 -- SAN JOAQUIN LOCAL HEALTH DISTRICT F&S 21677 REV. 7/76 3 �r.