77-616 - Laserfiche WebLink

Home Browse Search

r — 77--Irate rOR OFFICE USE: t, -0 -, -) - 17�) FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -7 ------------------ ------------ ---------- Permit No77_-_6l (Complete in Triplicate) - - ------------ ----------- ----------- ------------------- Date lssue,$7.`- ._.._`:-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 Ordinance o. 549 and existing Rules and Regulations: JOB ADDRESS/LOCAT N.... _. � ._ r------- _ ----------- -- 'i�--..- --- - - - CENSUS TRACT -- 4/ry Owner's Name_ -- -------------- p -- --- --- ---------- -- Phone-' Address------------------------ -- -----W,------------ - -- - --- --- --- --- City --------------Zip----------------- Contractor's Name Q i - -------------------------------------------- +� ; G`License #-- � g----Phone--- Installation will serve: ResidenceApartment House ❑ Commercial ❑ Trailer Court ❑ ` Motel ❑ Other--------------------------------------- p Number of living units:----- -------Number of bed oo�ms-3_.__G rba a Grinded------------Lot Size__Z_�_�_�------------------------------------- Water ---!�__._.-_._-___-.-__._-_ Water Supply: Public System and name------------ .r_____6�------------- - -------------------------------------Private FZILA Character of soil to a depth of 3 feet: Sand ❑ Silt ❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ � Hardpan:❑ Adobe 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 sewers available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK [q S!z ___41_ ___ ---------- --- __ ________Liquid Depth---- Capacity/;?-QC?-------Type_P-114 4 _Material__641- --------- Compartments-.---- 1021-7, _ ----- - --------- Distance to neare t: Wel I-------��Q _ __________________Foundation:._�.d__.____.________Prop. Line___-.a�-____ __________.. r q LEACHING LINE [� No. of Lines_______ __________________ Length of each lined---_/_d___7& ---Total Length ----0-70__.___._______________ 'D' Box----- ----Type Filter MateriaL____?)?QC_*De th Filter Material---A?------------------- Distance to nearest: Well__/46_Q_____________Foundation---pL_ ----------------Property Line.---11�------ SEEPAGE PIT [ ] Depth----------------Diameter-------------------.Number__________________._____________ Rock Filled Yes ❑ No Water Table Depth ---------------------------:----------------- Rock'Size------------ ----------------------------------- Distance to nearest: Well--------------------------------------------Foundation---------------------.----Prop, Line_______-_-___--._ REPAIR/ADDITION (Prev. Sanitation Permit#----------------------------------------------------Date------------------------------------------------) SepticTank (Specify Requirements)---------------------------------------------------------------------------------------------------------------- ---------------------------------- Disposal Field (Specify Requirements)-- -- ----------------------------------------------------------------------------------------------------------- --------------------------------------------------------------- (Draw existing and required addition on reverse side) I hereby certify that I have prepared ibis 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 spanner as to becom s let to t�rkm 's Compensation laws of California." Signed Signed----- -- --t- By- ---------------------------- Titlen-e--r- -- ' 0- - ----------- 7- µ (If other than o ner} FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------ --------CO------------------------------ -- -------------------------------------DATE---------7 -;V=77------------- DIVISION OF LAND NUMBER.. -------- - ----- ll --------- ---- - ---- -- ----DATE ADDITIONAL COMMENTS---- f. -.> lOi _ ► kr't G� ��Ati �-- - A L- - - via. _______________________ __ _ __ __________________________________________________________________________________________________ ____________p Final Inspection by:. - --- --- -- - Date. 4—--- "' � EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&5 21677 REV. 7176 3M