79-143 - Laserfiche WebLink

Home Browse Search

�[ FOR OFFICE USE: e, FOR OFFICE USE: •, j -" ! f V APPLICATION FOR SANITATION PERMIT f�- ?�1 --- ------ ------- --------------- (Complete in Triplicate) Date Issued-a`Z-��_-._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. 1 This application is made in compliance with County OlydinancgjN . 549 and existing Rules and Regulations: - P-_ JOB ADDRESS/LO�ATI N------..L------ - ---- ------ ---- ----- ------ -- CENSUS TRACT._ $ Phone_ 6� - ev Owner's Name.----KQ-------� -t----- --t-- - -------- ---- - - ------ -- ---City Zip ------------------- 4 1 Address_. --------- Contractor's Name .._..-_ -- l:�Ibs- ~ A- �-` d`g C�_�_��-� �icense # .. ��--Phone �: Installation will serve: Residence Apartment House ❑ _ Commercial ❑ Trailer Court ❑ Motel ❑ Other-----------------' --------- ---- -- Number of living units;___---------Number of bedrooms -- -_ -Garbage Grinder_7'jL'_?,;S__Lot Size--- } ��- ------- -------------- Water Supply: Public System and name-------------------------- ----------- ------------: ---------------Private Character of soil to a depth of 3 feet: Sand ElSilt ElClay ❑ Peat ❑ Sandy Loam Clay Loam E] 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: septicta6k or seepage pit permitted if public sewer is available within 200 feet) _ fi PACKAGE-TREATMENT [ ] SEPTIC TANK [ ] Size-----------------------------------------------------------Liquid Depth.------- ------------------ —Capacity -----T e----------------- -----Material----------:----------------No. Corripartments----------------------------- --- •V P Y------- ----- YP Distance to nearest: Well-------------- ---------------------------Foundation ----------------.----- Prop. Line----------- ---------- --- °� LEACHING LINE [ } No. of Lines- ------------- `------.Length of each line----------.-------------------Total Length ---- --;------------- ---------------- --- D' Box- Type Filter Material- ----- Depth Filter Material ____._ .___- ------------ r.� ',rt � _. ,r� yx�y..ara'-+�'r•._��.'- n-� �T+ Tom` .. '%..s- ..,. .. --�.. � T Distance to nearest: Well_ _ --{ e--.Foundation - ----- ---- : -Property Line .___J- __- Rock Filled Yes No SEEPAGE PIT [ ] Depth---------- ----Diameter-----'_---------:----Number---;----------- - ------ ❑ ❑ Water Table Depth----------=I-------- =- ---- Rock Size---- --------------- --------------------------- . Distance to nearest: Well `------ -----Foundation---------------------- -Prop. Line-- ----- ----------- 1 _ REPAIR/ADDITION (Prev. Sanitation Permit#------j----=----- -------------------- ----------Date--------------- -------------- t y --------------- ---------- -- ---------- ------------ Septic � - � { P Y Rqiw . ---------------- _..___.___- ents)Dispoal Field (Specify Requrem ----- ---'---------- ----------------------------------------- ------L U�'h -- - --------- I ------------------------------------------------------- ------------------------------------- ------------------------------ - -------- ----- - ----- - - ------------- -----,---------- (Draw existing and required addition on reverse side[ hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Count I 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 ubiect to arkm s CompeKsation;la`%4s of California." - Owner Sign�d�>- ------- -- --- r f By Q _,__11�� ------ --- ----a�J----------------- Title --------f e - --------------------------------------------- (If other than owner) FOR DEPARTMENT USE ONLY 1 APPLICATION ACCEPTED BY__.--- - - DATE--_-- �- -- --- -------- DIVISION OF LAND NUMBER.------------------------- --- DATE ADDITIONALCOMMENTS_------------------------ ----------------------------------- ---------------------- ------------------- ---------------------------- ------------------------ r ------------ ----- ---- Final Inspection b _ . �. ----------------'"-----.Date.---- ----- • -- ------- EH 13 24 SAN JOAQUI LOCAL HEALTH DISTRICT F&5 21677 REV. 7/76 3M i