78-539 - Laserfiche WebLink

Home Browse Search

n FOR OFFICE USE: FOR OFFICE USE: G ti APPLICATION FOR SANITATION PERMIT --------------------- ------- Permit No. (Complete in Triplicate) ---------------- ---- ----- --- - ------- --- ?-3 -7� Date Issued_.___._._.___.___.-- ' -------------------- ---- --------------------------- -- 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 No, 549 and existing Rules and Regulations: --------- -'-----------------CENSUS TR T ------------------ JO� ADDRESS/LOCATION__�___�--�� ..LlC� ' r -L -------------=-------.---.--------------------------±-------- --------.. e------------------------------------- Owner s Name.--------------------- ��-----'---�-P��-'------ -._..---------------------------------------- ,6- .......Cid:--op-1 -�- --- --�--Phony I Address---'- ------:---- l� Zi = - ]„ .` l - " -----------•------------------------ License # -- [ Phone .3__ ------ -------------- 1� Contractors Name._ p �/� 3. , f, - Installation,will,ssr e: Re encu' Apartment House.❑ Comm$rcral ❑ Trailer Court ❑ AA >L + Motel ❑ Other [ Number of living unitfs: _- --------- Number of bedroomsGarbage Grinder- _.______.LotSize._____._.._::,._'--- `._____._.___.___ Wciiter Supply:---PubtLckS�ste^mdand name--------------------------� - ------------------------------------------------------------� ---------------------------Private Character of soil to a depth o{3 feet -'Sa d ❑ ;,aSiit❑ Clay ❑ . Peat.[' Sandy Loam :Clay Loam 0 Hardpan ❑ Adobe.Q` Fill-Material--.,--._..._If yes;type_---=__�_ __________________ (PI n, showing size of lot, to atiioon of s_yste relQtidW-to'w.ells, buildings, etc rnust}be placed on reverse side.] EW STALLATION: :(No'septictank=or_Seepage.pit_pe mitted if public sewrer is available within 200 feet,) ' PACKAGE TREATMENT" [ ] SEPTIC TANK ['] Si _ /J�0 qDepth-., � _- t_ _ -- __ Liquid �--�.___-- r Capaci y �*_.---TYPel X -Material--- --------------------------No. Compartments-------�----------------------- ----------- ---------- ----- -- i Distance'to_nearest:,Well..._.��tU_1 V � 3 ` x�._. - Foundation _ l-5 �: __._ Pro . Line � v4 p LEACHING LINE _ [ ] Na. o�frZe � .-- _------LengthYeach line.-. _{ otal Length _ - :------------------- D,° -- ----' Type Filter aterra 'y� *L_Depth Filter Material_` _ _______________ ---- C(,stance to neeuest: V11e11- - __ _.f Foundation._ _ ..Property.Line . SEEPAGE PIT [ ] Depth----------- ----DiameteP-4'----Number--.--------------------------- Rock-Filled Yes ❑ No'❑ i Ater Table Depth +s`' ---------------------------------------Rock Size----------- ----- ---------------------- ------ i 1 ; '6istdflce to nebrest: Well __ _s - Foundation _.Prop. Line------_.__-___._--.-_ __ _,. -: 'Date----- - -= I - ------ - [ 1 REPAIR/ADDITION (Prey. Sanitatiotll a mit#_..__.__ _. ° ____ Septic Tank (Specify R uirements) _ = ---- -----°- ------------------------------------------------------------------- Disposal Field (5pecif�'Requirements).----- =----------- ------------------------------------------------------------------------------------------------------------- ------ - --------- - ---- f ---------------------�--]--------------------- - -- -------------- ---- ------------------------------------- ° -------------- ----------------- -------------------------------------- -------------- ---- -- ----------------------------------------------------- - -- f {(Draw existing .Ad required'additio;z_con everse side] ...i_ f I hereby certify that I have prepared'thi•s application.l"and that the work%:will be-done -in accordance with San Joaquin County Ordinances, State Laws, and Rules and"Regula lions�of-the S'a_n'loaquin Local Health District. Home owner or licensed agents signature certifies the'following: "I certify that in -the performdnt of the work for whkibhi s_!permit is issued, 1 iholl not employ any person in such manner as to become subipct--ta Workmanompensation laws..of California.". ' i' msµ=• .{ Signed ---- - - = Owner_.._ ' BY ''" � =- ---..Title - ---- ------- - �l`f other than owner) ��'� DEPARTMENT USE ONLY r ]' APPLICATION ACCEPTED BY___-= -- DATEr'. .-- .-- - 7 ------------- t r --- _ i 1 DIVISION Of LAND NUMBER.--------_-'--- '- DAT.E_:--.----------'---'__--'- - ------------- --- - - - .. i i € - - - ADDITIONAL COMMENTS-..------ -- " - ' - ------------------- ------------- " ' I - ----------- ------------------F--- -------------------------------- ------------------- -------------------------- ---- ----------- --------------- -- t : - -- - - --------- -'=-- -' ------ J ----'Final Inspection by -- -'------ ---------'-----'----------._Date EH 13 24 HEALTH DISTRICT 21677'REV.