SU0004820_SSNL - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: FOR OFFICE USE: APPLICATION FGA SANITATION PERMIT € (Complete in Triplicate) Permit Date Issued_.�- __ 77 _____________________ -------- This Permit Expires 1 Ye Fpm`Dale Issued ,.J plication is hereby made to the San Joaquin Local Health District for a pee(nit to.construct and.install the work herein described. �Tils application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: DB ADDRESS/LOCATION-.�17�1.. _ ..- _ ��`-- ----------------------------CENSUS TRACT_ ..... War's Name - -G r -------- ----------------------- dress --------------------- Phone_ �5 dress----------- --- -- ------------------------------ -------City--- Zip------------- ----- ontractor's Name- — -- -- --- - -------+r —----------License --------------Phone ----- T -- Installation will serve: Residence R - Apartment House ;Commercial E] Trailer Court ❑ P ❑ ----------------------- Lumbe'r of living units:--------------__Number of b6roorri; _.�-_-_-_Garbage Grinder.-_-.--_--_Lot,Size------/-. -1------------------------------------ Water Supply: Public System and Warne -= 'a �?! t.; :--------�-'------------------ ---------------------------------------------- Private �--- Hardpafeet:, Sand"'F Silt[� Clay [] Peat❑ Sandy Loam ❑ Clay Loam KJ-- erecter of soil to a depth of 3 n Adobe ! Fill M aria)_._..____._ P ❑ alt -If yeS,tY�Pe r, 'lot plan, showing size of lot, location of s�rsiem it relation to s, buildings, a_1 :must be placed on reverse side.) EW INSTALLATION: (No septic flank or seepage pit Dermitted'if public sewerPlS available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK [ Size__-. XJT_ /J -�. -----------Liquid Depth------ ----------- ------ ---.-. -- } �Pe ----.--No. Compartments..,_- Ca aci�Y- r______-Mateial___ Ll ) Distance to nearest: Welk .,;.•_ . ' � ' . / ' 'xr .. '-----------------------------�F_o�.undat/ion-----1A-------------- ----- - -_P_ro_ . Li ne- 1 --- -`--- -------- . EACHiNG LINE No, of L�aes - �ength of each line----- p ---------------Total Length-----f _____________.__. _.._ al_J�I_3-Depth Fi. r Material TYPe Filter Mater! __________ � S72 P/ SEEPAGE PIT Qe th_ 'eta nearest: Well _ ; ----_-_-._--Foundatign----=— ---_-- -- - Distance ----___--.Property Line------------- - --- L ---------•- p �S ,----Diameter--_-- ------- -Number-__--_- -_/ :.-_-_-_-_ Rock Filled Yes jg--No-o� Water Table depth. -------- l ------------- ------- Rock Size------------------- TT ----------------- Distance.to nearest: Well-----� f__________-----------1.. .Foundation,- _ ��rop, Line_/ } tEPAIR/ADDITION (Prev. Sanitation Permit#_ _____________ _'__ ______:_ __=___=F --------------------------- -------------) ' Se otic Tank (Specify Requirements)------------------- --------------- -------- --------------------=- ------ - ------------------ D ------isposal Field{Specify Requirements)------- ---- ' w..., r_,_--•-- ------------------------------------------ ----------------------------------------------- ------------ ------------------------ -.-_---..____._..__.__..__.. t__._____'___ ______ ____. s t _.______.__...____.______.._-__-__._._____.______ (Draw exisfi6g.and &Jdfrg �a�lditlail on reveap side)'. hereby certify that l haveP Pre ared this a lication'gnd Fhat�,�.rk will be done inoauor&nse, with San Joaquin County P P State Laws, and (Rules and Regulatione"ofi theh_Joaquin Local Healt� District, Home owner or licensed agents signature certifies the following: : y p per "1 155Ged, I shall not employ any person in such manner as `I certify that in the performance of the work For which this m� ' to become subject to Workman's Compensation laws of C•41if6rnia." Signed- --------------- -----------------------------Owner •..,._: ` _'' t --- - --------------- - ---------- .Title E # (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - - ------DATE. 7 DIVISION OF LAND NUMBER--- ------ ------------------------------------ -- DATE ADDITIONALCOMMENTS------------------------- ----------------------•--------------------------------------------- ------------ --- -- ------------------------- --- ------------------------ ------d- 1 1 . ---------------------- - -- -------------------------------------------- --- ` LFinal Inspection bY------------------------� / -- -------------- ------ r .. Rt 19 OA CAwI 1^Ar%111A1 I UCAITI..I nlcTnl/•'T FJLR 71 R77 RFV