SU0012456 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT y+.... ..,. .^....`.... _ iCotnplete in,Triplicatt) �. __ Permit No. ..; ..s...� . .,......... ......I............I............................... This Permit Expires 1 Year from Date Issued Date Issued .. 7: : �S' Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein described. This application is made In compliance with County Ordinance No. 549 and existing Rules and Regulationss JOS ADDRESS/LOCATION ..-Z. :..So.-.._ -... S. -_ CENSUS TRACT ................:......... Owner's Name . .. ...r.. � ............. .......... ... ....... ........................... _ Phone . l t Address ...... /7 a�.... ...... City QQTsD .----....,// Contractor's Name ..... r S....sr- ............:..........Licert:e 9!t/7��? Phone Installation will serve: Residence iff Apartment House[] Commercial[ITraller Court E] Number of living units:... ..... Number of bedrooms _.Garbage Grinder ....0...... Lot Size ... ...... .. ...... Water Supply: Public System and name ... ................................_.......................................Private❑. y Character of soil to a depth of 3 feet: Sand j] Slit❑ Clay ❑ Peat Q Sandy Loam{] Clay Loam ❑ Hardpan Q Adobe 0 fill Material............If yes,type............... ............ (Piot plan, showing size of lot, location of system In relation to wells; buildings, etc. must be placed on reverse slde.1 S j NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,j PACKAGE TREATMENT SEPTIC TANKPq Size/X-5M& .0Zi� f........... Liquid Depth ..S................... f� Capacity ........... Type ...:.. ......:.. Material-K,0..� ' ?Z'No. Compartments ...�:......... Distance.to neares Weil ..:Z .....................Foundation �a .......... Prop. Une ../,.$- .... .. ... . LEACHING LINE No. of Lines ....... �c] ..... Length of each fine....../.C10 �,� Total Length ... ............... 'D' Box ...*f..... Type Filter Material .�..�-.�Oepth Fl)ter Material ..... lf •l Distance to nearest., Well ....... Foundation .....7?.-........... Property Line ........................ z SEEPAGE PIT PQ Depth -Z7�...... Diameter %..9..., dumber ............/.......� Rock Filled Yes A No 0 Water Table Depth ....j�.Q..r.............................Rock Size ..../......--••---•---•-- 'Distance to nearest. Well .....Z.S.. .......................Foundation -7??:........... Prop. Line ..._.._.----_.--__. REPAIR/ADDITION(Prev. Sonitalion Permit ...... Date ................. ) Septic Tank (Specify Requirements)... ...........:..............::...........................-....................... Di s osal Field (Specify Requirements) -••--•--...�_ _` 'q- `........ a�pa -t....: •...... .moi'--• •:�� •-�-�� ------.�f+-c•... .2.•�.rzil__.. ... ..�. ..._._. r - ir.�... .. . ......... !Draw existing and requirrs ed addition on revee side) /�z / � 1 hereby certify that I have prepared,this application and that the work will be do acro nnce t jobilmn� County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local HealdvOlslrict.Hoene owner or pcen- sed agents signature certifies the following: "1 certify that in the performance of the world for which this permit is issued, I shalt not employ any person in such manner r as to become subject to Workman's Compensation laws of California." . Signed .�v.7-f -. -reset -7....................................... Owner By .......................................... .............................................. Title (If other than owner) I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .. . `� /---- -------- --1- .:P'.- ------- DATE....... ..... •._- - BUILDING PERMIT ISSUED ........................ .... ... . _DATE ............................................ ADDITIONAL'COMMENTS .................. ---------•-•-••.............................•------- •• ..---------- ..... .-- -•----...... ----........_._.......... --... _..... ..................... -------•........................... .. .......... ... .. ... ... -- ---_..Date ..... .� Final Inspection by: ..........................•--._......-•-•--LAQUIN - 6----.��... ..._...... .�.fi..t� ...... (( ----��,�...� ...._... EH 13 2b 1-68 Rev. 5m S. ZOCAL EAZDiSTRICT M >� t /7W 3