SU0006409 SSCRPT - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: (,"P' .ICATION FOR SANITATION PhI ' Permit No. .`�� 3 (Complete in Triplicate} _.� . .._...._ .................... This Permit Expires 1 Year From Date Issued Date issued --- . + Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein F� described. This appiirationAs Made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LO N .._......,. t Lt -rtc��. mac _. -....._ CENSUS TRACT �... Owner's Name - " :. .r...............................- =• '. ------.Phone ................................ Address 1 ......••-- _ G :. ---,--. City -z��c ................................... IE F' Contractor's Name � � ---........ .. .__4 '.:. . ._.. .. .. .. �L_ .�:. :',_r-1- License # .. -_ Phone . Installation will serve: Residence Rl"Aportment House 4] Commercial OTroiler Court Motel ❑Other ............................................ {Number of living units;-- .....�__ Number of bedrooms .......Garbage Grinder ............ Lot Size ------_---------------- ............ Water Supply: Public System and name ----•-=-----•-•-• ----•-------------...... -------------............................ •---------•------- Private Character of soil to a depth of 3 feet: Sand 0 . Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Gay Loom 13 Hardpan ❑ Adobe❑ Fill Material ....... If yes,type •-•--•...................... (Piot pian, showing size of lot, location of. system in relation to wells, buildings, etc. must be placed on reverse side:} FNEW INSTALLATION: (No septic tank or see ge pit permitted if public sewer is available within 200 feet,} C k , PACKAGE TREATMENT O SEPTIC TANK } Size_••__ _z'L._-_Z-Z.. X. __----____ Liquid Depth .. .................... r r 611k:Z�l Capacity 4'.� Type ... Material No. Compartments ._ -Distance to nearest:. Well ........... ..................Foundation IC%........... Prop.Line'_:: ............ {LEACHING LINE (� No. of Lines ------�-.--__ g g Length of each line.------/..�?:c .__.--- Total Length _._....._..:. - ...De Depth Filter Material _-- -i_- 'D' Box ----/...... Type Filter Material ----------------• p ._.. ........ r r Distance to nearest: Well _.... J./ ..__.. Foundation _____f ........_ Property Line __..5.... ........... . Depth -__.f .-�--.- Diameter 1=---r a Number _._.------............. Rock Filled Yes j�No ❑ Water Table Depth //G,Z ..Rock Size ............................f� Distance to nearest: Well IC.�%....................Foundation ..._!_L1_. __---- Prop. Line ------ ............. . . REPAIR/ADDITION(Prev. Sanitation Permit�# -----------------•---••---------•----.------ Date ..................................I SepticTank (Specify Requirements) --------------------------------------------------•----•------------•---------------•------...............M._...---------................ Disposal Field (Specify Requirements) --------•----------••------------------------------------------------•-----....----........_....----•----•------ •••--•-•----•-•--- k --------------------------•----------.__-------•-------••--•-•-••-•-••----- ------------------------------------•--------------.....................................•-----••---"-••••-------- J ----•.-•----•---------•-------------------•-------------------------------------- --------_.----------------..........................----------------------------------------------------------- ..-•---- (brow 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 local Health District. Home owner or licen- F,sed agents signature certifies the following: g:"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 ------------------------ > ..................... Owner F.By ---_------------------------ �'-� � ' t .. `��Z� xitle ._..-. -.--------------•--- (If other than owner) FOR DEPARTMENT USE ONLY F.,APPLICATION ACCEPTED BY ,,... _ .._....__ ._----•..............--------------........................DATE __ _.--? .7 --------- - BUILDING PERMIT ISSUED ....... ----------------------------------------------••-.......................................DATE --•-- ................................ ADDITIONALCOMMENTS ------------------------•-----•-••--------_-----__-----•---•---------•-- -------------------------------•--------•---- •----------=•--...._..._........---- -----_.-•_--_-.__--..---.-----••----••--------- -- - --• - -- ----- - ------• ------•-----•-----•-----•----•----•-------------•-. -----•---.--__--•---•-••----•------•------•---•--_-----•---.- ...............:.I.,......_--._.......... ...... -----•. ... . ..........................................-_....---••_.... --- .__.....•----_--••7� ---- .--•-- Final Inspection by: x...,__._ _.. .........Date . 2..: Z------�•-----._--. -_ SAN JOAQUIN LOCAL HEALTH DISTRICT