SR0080503 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: I APPLICATJO ..:R`NITATIONAMIT -:ate .. J-_ Permit No. � ...... , III (Complete in Triplicate) ...... --•••-" . Date Issued _o2Y ' .----._.....__..... ll. This Permit txpires 1 Year From Date Issued 2f —0570--CP Application is hereby made lto the Son 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: JOB ADDRESS/LOCATI N 4/ iEr�ON ,�' N - T•{ D'1ff� '"• nf(. nr�.- I Cfl�s� fRACT S. { Ph Owner's Name ----- -- - �t`�'---------------------•--------•-•-- -- . _ � ,3 :city . ,� �. Address --------------- --:-?- ....--- - -- - - ------------ -- ------------ -•------ :.>..? Contructor's Name .- c v - -•-• ---- �- License # - Phone .. Installation will serve: I� Residence ❑Apartment House Commercial Trailer Court ❑��t.wv� Cvd/ j " Motel ❑Other .'.............. 0' 3) 3�'- i Number of living units:. Number of be rooms ............Garbage Grinder ...._. .... Lot Size __------ ---------------_.__.._-.._---.-. Water Supply: Public System and name .. _A49 Ut ..._. . --- -- -- - - - --._..------ Private _ ❑ Character of soil to a depth'lof 3 feet: Sand E] Silt❑ Clay ❑ Peau Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material .........-_ If yes, type ------""... ' - N (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) I C) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) t PACKAGE TREATMENT I ] I SEPTIC TANK [ ] Size__... _....................--..-_------- ---- liquid Depth ........................... , Capacity ------------•- Type ------- --------- Material----- -- ----------- No. Compartments . ------------- tP4 _ Distance to nearest: Well ___.._.-. .Foundation -------- ..____-- _. Prop. line --------------------_ t- I LEACHINGLINE [ ] No'of Lines ........ _ ......... Length of each line........ .. ................ Total Length __........._.__.._____...._! f 'D'!IBox .___ _.__ Type Filter Material ____________________Depth Filter Material _ _ _ _ . ---••- Property Eine ---- ---_------------ 11R --_--••-------- ; t Distance to nearest: Well . ------------ ..._ Foundation ..... .._ p ty - { {'S , J r 11 SEEPAG&PIT ' Depth ._... ... Diameter .._. Number -------- _............... Rock Filled Yes F-1 No �l f l •1 Water Table Depth ------•- Rock Size ------------- -•---- ist: Well __..._.___ ..Foundation ---- Prop. Line ---- ----•-••-•-•----- - Distance to neare REPAIR/ADDITION G (Prey. Sanitation Permit . _.__-___.--_ Dat _ ) ! Septic Tank (Specify Requirements, i:112! !o " ---- -•- IOT�11(J)1 - t I Disposal Field (Specify Requiremen ....------ .. II ------- ------- - ---------------------------- {Draw existing and required addition on reverse side) I hereby certify that 1 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 the San Joaquin Local Health District. Rome owner or licen- sed 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 subject.to.Workman`s Compensation laws of California." j Sig d -------.... . .............kA .......�------- - - -- ...................... __ Owner By . . ............ Title ...... .............. {If o her than' owner) I� FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_.. --- ------- -------------- DATE . s ..: `�� .....------- BUILDING PERMIT ISSUED;I DATE ADDIT NAL C ME�J S � ..3. :cry::-................. -::::".'-:.rn_P.�::.:�->�_:`."__ :- -- - ------��.��•- --- -- ...----:::...... �.. - --- - -- .�.:.._:_ �� ----- Date _...3 .-r. ...... -- Final Inspection by: --------------------------------- ........ SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M.