78-674 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: PIP INV-*G t FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ------------ ------------------------ Permit II {Complete in Triplicate} --------- ---------------- ................. This Permit Expires 1 Year From Date Issued Date „r Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. 'h! happlication is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOC TION..._' .._ / r r � �- -- -------=---.CENSUS TRACT--------- . 1� Owner's Name._== {:�r L .r:: - ---- - -- ' -. _.Phon l0 Address - - ------------ --- ---- --- ---- ------- -- - - 'Ci}� J Z'p Contractor's Name __�060,45.y ------- --------- ------- --- ------ --.-License # ------ .-------Phone__Tfv�_.-/ ------- d Irilstallation will serve: Residence ❑ Apartment House.[:] Commercial ❑ 3railer Court ❑ Motel ❑ Other---'-..: = el Number of,living units:__ _-[__--____.Number of bedroom ___Gar'bage Grinder.___.__.__Lot.Size___._ d- ,_ X_�Ca Water Supply: Public System and name---------- - _ : ----- ----------- --------------- --'------------------------------------------------------ --Private ❑ C 4aracter of soil to a depth of 3 feet: Sand Silt Cla Peat Sand Loam Clay Loam : P ❑ ❑ Y ❑ ❑ Y Y . ❑ Hardpan ❑ Adobe Fill Material_.,__'. -- - fYes, type -- ---- --- (Piot plan,'showing size of lot, location of'system in'relationfto.wells, buildings, efc. must be placed on reverse side.] 4 _ . NEW INSTALLATION:' (No''septic tank ,or seepage .pit permitted if public sewer�js available within 200 feet,) PA, cul L /�'_� SEPTIC TANK SizelCKAGE TREATMENT [ ] 'Z_Q�_____ __ �------------------Liquid Depth------- _____________#---- Capacity----- ,,�_., iype/ Cagf=Ma enol : i P-Na-Compartments -----• =2 --------- 1s .,. Distance to nearest: Well,.U. '�. .-- j. -,-- Fourl at'on ----- .._Prop. Line------------ ----------- ' 7 LEACHING LINE [_] No. of,Lines !__r� -------------- x% of each iina�]1-- ____,.Total .Length _______:. �_ G___ _____ ti° D' Bo i T e Filter Material �1D�& -'De th FilteriMaterial___ p t tYp v p �t.. 'yfl - f-- ------ # Distance to rest: Well ' / O L"'_ ' Faun 0-- t Property Line -------------------------------- c t V �:f. _ - v i r SEEPAGE PIT [ ] Dept Diameter_ Number_ __ Rock Filled Yes No ❑ i� Water Table,.Depth- i i ---- - ---------------------------R ock,Size F i Distance.to nearest: Well -----1 --..Foundation.--------- -- Prop. Line____-__.___________________ REPAIR/ADDITION (Prev.,Sanitation'Permit# ----------------------- __ ___.Date ._-._ _ hn _ 1 1 ]� Sp#ic Tank [Specify'Requirements] ::-- = -- = = k _ -----------= ------ ----------- -------- 11 Disposal Field (SpecifyvRequire`rrents)-]--- ------------- -:_---=---_-;-----•------ ----------- - -----=--- ------------------------------ `------------------------------• ----- IId _ � . -- { . . . --------------- -------- ------ -- .- - ------------------- --+-�- ---------------- ------------------------- ---------------=-------------- ------=---- -------------- ---------------------- --------------------------- ;I ( til � Dr'aw existing-'an' r_equired:a.ddition on reverse side] I hereby certify that havetprepared this application and that-Ahe work will- -be done in cordance with San Joaquin County Ordinances, State Laws, and Rues-wand Regulations of the' San Joaquin Local Health district, Home owner or licensed agents signature certifies the following: f certify that in the performanc of th work for wKi'ch flus permit is issued, I shall not employ any person in such manner as to become ect to Workman' pensation laws .of California." ] i Signed --- ------------- ----- ----- ---.--------------- Owner _ w� BY--------------------- --- --- ----- - -------------- ------=------- ------------Title------------ - (If other than owner]_ k ,r F DEP TMENT'USE ONLY,- APPLICATION NLY`APPLICATION ACCEPTED BY"-----=-- - _----- -- --------------------------------------------------DATE-----------r.. Z. - - N OF LAND NUMBER. ------------- ----- -----.- DATE. D1VI510 AdDITIONAL COMMENTS---- --- ------- -- ------ - - ------ --- �-- --- -------------- ------`----- ---- -- -------- ---------- --------- --- ----- -------------------------------- ------------ ------------------------- ------- -k�� -- -- i Glu - � . ----_------ ---------------- - -- ----- ---------------------------------------Date.------='--------- '----- EH 13 24 S JOAQUIN LOCAL ALTH DISTRICT F&5 21677 REV. 7176 3M