SR0079323 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FORSANITATION PERMIT ....................... ......... .. ........................ .... .................. (Complete in Triplicate) Permit No ...................... ...... This Permit Expires ? Year from Doh Issued 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 544 and existing Rules and Regulations: JOB AODRESS/LOCATION ..�d/LU �f.-_...��¢E. CENSUS TRACT Owner's Name _.......pp ..................... ........ ...,.. Phone ...` Address....... ......._.....P. C)' .� �/L.._ _ 'G.7. .....__....................., City .. ............__._ ...... .. Contractor's Nome .............•_-- -_---- _ r.---- Cl�� ..._.License!.y.,�.:.. Phone `� Installation will serve: Residence p Apartm� Ho' of] mercial flTrai[er Court Motel ❑ Other .. ... ...................... Number of living units: ............ Number of bedrooms ............Garbage Gr i er .... ..... Lot Size ............................................ Water Supply: Public System and name ............................. ...................... .... ....... ............................ Private 0 Character. of soil to a depth of 3 feet: Sand E] Sllt ❑ Clay Q Peat ❑ Sandy Loam Q Clay Loam o Hardpan [3 -.,Adobe Fill Materlol- - _...... 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 sewer is available within 200 feet,} f, PACKAGE TREATMENT [I SEPTICTANK Size... 7Z..�.................._._... Liquid Depth .............. i Capacity f. Type ...... Material ...t1 r1_Zi! - No. Compartments ...2 �............. O Distance to nearest: Wel] ....................................Foundation ..._............ Prop. Line ............. O LEACHING LINE �j No. of Lines :.__...._l Length of /g'_ach line...... 0-0............. Total Length ....1/�.0... ............ i l 0' Bax Type Filter Materia! .........Depth Filter Material ........ g.. r ...................... Distance to nearest: Well ............. ........ Foundation .._.�..�............ Property Line _ �f .�............. r �. SEEPAGE PIT � Depth ._.,2...5 ........ Diameter-.,�..5-..__- Number ........�..�.......... Rry FHled Yes � No E Water Table Depth ................................................ Rock Size ..�....... Distance to nearest: Well ........................................ Foundation ...... �P r.... 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 this application and that the work will be done In accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of_fhe San Joaquin Local Heahh:Dlstrfct. Home owner or licen- sed agents signature certifies the following: "1 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 subject to Work an's Compensation laws of California." Signed ............... ---�tiho .----•-._._.. .._. .... -a -------------.-.._........_ Owner $y ...... WVV;ork an's Title........... �_............. ......................... ....... (if othecaned FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --- BUILDING PERMIT ... ... .......... ................ �........:. DATE .........c.. E ADDITIONAL COMMENTS - --�. _ ` .P?_..... ......................................•---•--._.....-------------•------.--...........--• •...................................... ........................ -----..-. -a--...ti....:.:.fi ...r......-.-7-..�. .-. .-.-.-.-.-..........-.-.-.-.- .........--•-•.........................._ .: ................. to .... s.:. � ;� .................. Final Inspection by:...... � ... ..---- . ............................................................. .... ................ Date ............ ...,7..... ---------------- EH 13 24 1-68 V. SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M