78-792 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: FOR OFFICE USE: ---- ------------------------ APPLICATION FOR SANITATION PERMIT ---- - (Complete in Triplicate) Permit --------------------------------------------------------- -- Date Issued-__ _lS`-7 ---------------_--------___ 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 application is made in compliance with County Qrdinance No. 549 and existing Rules and Regulations: a JOB ADDRESS/LOCATION .CENSUS TRACT---------------------- .--�-- ��. ._��? �� ---------- �� -----..-....._ Owner's Name-------- --- - -------- ---6 --- - ---- --- ------------------------ ----- --- ---- ---------- -------------Phone-------------------------------------- Address - � ��1 City..-.... Zip----------------- -- Contractor's Name.--------- �,1�iXsc�ee ,. / _ License #_._ Z _..__Z .-Phone...__..... Installation will serve: Residence ❑ Apartment House ❑ Cam erci ❑ Trailer Court ❑ Motel ❑ Other.___ Number of living units----- ----------Number of bedrooms.-_.__GarbageGrinder------------Lot Size-.--- __. .._. Water Supply: Public System and name----r--------- ------- --------------------- ------------------------- --- ------------- -----------------------------------Private Character of soil to a depth of 3 feet: Sand Silt Clay (] Peat Sandy Loam Clay Loam E]Hardpan �/ El ❑ E]Adobe❑ Fill Material............. 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 ( Size_ __��.��._�______.--------- Liquid Depth/ NA —Capacity/11W-------=--TYPe Material--- No. Compartments-------�--- ------------------ �istance to nearest: Well_ _ �e��-----� ---------------Foundation.______.1n�(.--.Prop. Line-_ LEACHING LINE [)' No. of Lines---------___�_______--__ Length of each line-------- h .___.Total Length __-__PCS __ ______---____________ 'D' Box----1-----T a Filter Material....._ /� �� YP ��----.Depth�Fiiter Mafierial ------1--1----------------------------------------------- Distance to nearest: Well------��_ Foundation._----- -------Property Property Line________ -------- SEEPAGE -__ ---SEEPAGE PIT Depth---- _...Diameter... ��_____ ❑ 3..� Number_._______�________________ Rock Fillet! Yes No Water Table Depth-------- 1�1 ---------- ------------ � 3 " Rock 5ize__ ._-- / Distance to nearest: We11___ - Foundation_. e/ _.Prop. Line___✓._--__._ REPAIR/ADDITION (Prev. Sanitation Permit#--------------------------------------------------Date-.-------------------------------------------_] / SepticTank (Specify Requirements)----------------------- -- ------------------------------------------- --------------------------------------------------------------------- -------------- Disposal Field {Specify Requirements)------------------------- ----- �------------------------ =--------------------------------------------------------------------------- ----------- -- ------ ---- ----- --------------------- ----------------------------------- ----- ------- ---------- r fi (Draw existing and required addition on reverse side) hereby certify that I have prepared this application end 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: R "I certify that in the perforriiance -9f ark for which;.this:permit is issued, I shall not employ any person in such manner as to become subject to Workma ompe sati laws of California." Signed- ---------- -------- ----------------- - - T( -------Owner t u BY-=----- ----------- - ------- --------------------- -- - ----- `'--------Title--.-f✓il C[! (If other than owner) r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- -'-- DATE.-- - -( -0------------------------- DIVISION OF LAND NUMBER------------- - -- -- --------------------------------------------------------------- DATE ADDITIONALCOMMENTS--------------------------------------------- x-----------------------------_•------------------- ----------------------------- -------------- --------------------------------------------------- ------------------ ---------------------------------------------------------- -------------------------------------------- -------------------------- ----------------------------------- _ -- Fina! Inspection by: Date - - ---------- Final - ----- --------- EH 13 24 SAN OAQUIN LOCAL HEALTH DISTRICT F&5 21677 REV. 7/76 3M