SU0004970 SSNL - Laserfiche WebLink

Home Browse Search

4. ..._... �F°R(C1- Ott1ANI��TIC9RI pl=Rl�1l� ........... (Complete in Triplicate) ................................... Permit No. _2 This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for 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/LOCAT O .............��{... . ..� ... .. NSUS TRACT i Owner's Name ........ Phan ........ = .....•---------- ..................... a . ........ � Address ............ _.. City .. .............. _._........_.._.... Contractor's Name ..- l Phone . License # Installation will serve: Residence Apartment House{] Commercial ❑Trailer Court Motel ❑Other .............................. Number of living units:............ Number of bedrooms ............Garbage Grinder ............ Lot Size . _.._.__._...- Water Supply: Public System and name ...................................................__.._..................._..............---......---•........Private P<j— Character of soil to a depth of 3 feet: Sand❑ Silt❑ -Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam 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: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK{ ] Size...............................I................ Liquid Depth .................--------- Capacity ... Material................... No, Compartments Distance to nearest: Well ........f,.,�,Q.. . .........Foundation ...................... Prop. Line ......................S LEACHING LINE [ ] No. of Lines .......................... Length o each line............................ Total Length 'D' Box ............ Type Filter Material ....................Depth Filter Material ............................................ n Distance to nearest: Well ........................ Foundation Property Line ...........__.._......... SEEPAGE PIT [ ) Depth Diameter ................ Number ...........................-.'Rock Filled Yes ❑ No ❑ Water Table Depth _-Rock Size Distance to nearest: Well ........................................Foundation ..._......... ...... Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date .................................. Septic Tank ISpecify Requirements) Disposal Field (Specify Requirements} ,- ,-,�� Q ,Clf ,1.., .�o .q{ ' ............................................................I........ ................................................ ,.. ... .... tic ........ ................. (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 the San'Joaquin Laical Health District. Horne owner or licen- sed agents signature certifies the following: "I certify Shat 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," Signed ....... . .... ..... .... ............._..............__. Owner BY . . ....... Yitle . (If other than ner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .. _ .. ..-....................... .............. ........................................ DATE ....S.,a. ............... BUILDINGPERMIT ISSUED .. .... ..... ......-•----........:--•--•........................ ......•-•---..DATE _.._....................... ............... ADDITIONAL COMMENTS ...................................... ......_............_........ ............:....................._....._..._._............_...:........................... i .......................................... •.........._.......:............._.._......................-•-•-•••••-•-•--••-•.__..................................._.._...........•...._................ ................................. .... .:.......:.-•--.....................I..---..........(........._..............--------------.. . ...-.....Final Inspection by: .. ....... . Date . . . i ...... ....... SAN JOAQUIN LOCAL'' iaALTH DISTRICT