SU0004545 SSNL - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT // -- - (Complete in Triplicate) Permit No.._� '-T _ Date Issued_-�' '�� 'f ..-._ . .._,_- _.,-"...,,,,,.....,.................... - This Permit Expires-1 Year From 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. 549 and existing Rules a9si Regulations: JOB ADDRESS/LOCATION ---- __--- -____. - _.. _..�'. ).(r r /�� ' w//�y. ./3 %i- ------------ -----CENSUS TRACT--.-_--- Owner's Name__ �`7q Pit'Ti i�e,.j¢rfit•;Ct----... ....... ------__-- _------.--- Phone Address i ,. .._.- itct�cn�-� e ---; -- -.._- City .Triscy ------ ---- ---_.Zip ----------------._..------- Contractor's Name .-License -Phone,!%;3' y't Installation will serve: Residence ❑ Apartment House E] Commercial JN Trailer Court ❑ Motel ❑ Other- . - - - --- ------ Number of living units:__.- ....Number of bedrooms---- Garbage Grinder__.._-__Lot Size____________ 1 1 Water Supply: Public System and name------------------ ------------------'--•--------------------------------------------...-__......_------Private E]Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay E] 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 p it, permitted if public sewer is available within 200 feet,] - -- _... - Liquid Depth - PACKAGE TREATMENT [ ] SEPTIC TANK [ ] Size --_.':-:. _ _ Q - - j.1 Capacity./, d------Type 4�C Cih Jr�Material ;.GUn/4 -----No. Compartments .- -p. - ----- -- ---- Distance to nearest: Well --:-"Do r # ..; S Foundation_..Jp• -.--....-.Prop. Line -5r�1_' ` LEACHING LINE [ ] No. of Lines......34F------ -.___Length 10' eailh I"i ✓ Total Length_. 6o0 V 'D' Box- ------__Type Filter Material - 'pepTh Filler Material- •"Ta- . Distance to nearet: Well .� "-- .a inion-"- y G�_-_ - Property Line_. SEEPAGE PIT [ j Depth_.- Diameter_ _ ......:.. "---:..Num ler."-"_-.-_-- _"..--._-._._ Rock Filled Yes ❑ No[I Water Table Depth.------------------------- -'----------- -------' Rock Size._..."_.------...------------------- [. .- _.T Distance to nearesh-Well _--___;_____-"-._'Foundation_-___.____-__----Prop. Line.._-_.-"._---"--... - -- REPAIR/ADDITION (Prev. Sanitation Permit#------- _- ---------------------------------------Date"--_."------------- ---------) Septic Tank (Specify,Requirements)------- ----- -- - Disposal Field (Specify Requirements)" - _.._... -..... - ------------------------- -------------------------- ------ -- -"---- ----------------- .......... ._._I:. '. ---------------- --------- ............ - -------------I------------ ------------- - (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 i, the San Joaquiri`Local Health District. Home owner or licensed 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." Signed A.Zlz0Bge 4�a'oey _----Owner -....---.Title -------.._ ......... - ------- other than owner[ FOR DEPARTMENT USE NLY APPLICATION ACCEPTED BY....... - - - - - - DATE . ADDITIONAL-COMMEN - ' * DATE - DIVISION OF LAND NUMBER. �) n .. .. --— ti ---- --- -- -------------------- - - ------------ ----------------- Z:------------------ -- ......- -- - --------------------....._.. --------- ------- Final Inspection n- -bY - 7- -- .-.Date - EH - -- 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F6S 21677 REV.7/76 JM