SU0006547 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: -- - --------------------------------------------------- -------------- -------- -- - -----------. —*4PPLICATION FOR SANITATION PEWIT 1 i - -�-�---?1 [Complete in Triplicate] Permit No: ---------=----------------------------------------------- - ----------- This Permit Expires 1 Year From Date Issued Date Issued _u _-_ .i 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 Ordingnce No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION-1 -------�--- --- ----------------- ------------- �r�....:. ----=-------- --CENSUS TRACT ----------------------..-- Owner's Name --- -- ----------- - --•------------------------- ------ - - Phone - .------•-----------------------•-- AddressLl T --- ------ ------------ City --- ----------------------------------------------•------ C. f Contractor's Name - -- -----`�` --. ------ 4`?�-.License # &73_,F?''_ Phone -------------------•-_------- Installation will serve: Residence Apartment House E] Commercial: Trailer Court ;❑ Motel ❑ Other ----------- Number of living units:.--_ ------ Number of bedrooms ------------Garbage Grinder ------ Lot Size ----- -- --. Water Supply: Public System and name ------------------------------------------------------------------------------------- Private [�J Character of soil to a deptKof 3 feet: Sand'❑ Silt E] Clay ❑ Peat E] Sandy Loam [?Clay Loam.❑ i i Hardpan ❑ Adobe.E] 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---------------•-------------------------------- Liquid Depth --------------------------- Ca,pacity --------------------- Type_L- -------Material-=----------- == No. Compartments ---------- Distance -----Distance to nearest: Wel! ------- !j, ---------------------- Prop. Line -_,-------------- .-_-- i LEACHING LINE [ ] No`. of Lines ------------------------ Length of each line---------------------------- Total Length ---------._-..-..__._-----_- 67\1 . D'I�Box ------------ Type Filter Material --------------------Depth Filter Material --------------------------------------- Distance to nearest: Well ------------------------ Foundation ------------------------ Property Line ---_----_.....__-_.-•-__ c SEEPAGE PIT [ ] Depth --- --- Diameter ---------------- Number - ------------------------- Rock Filled Yes [] No 1❑ Wa11ter Table Depth --------------------------------------- --------Rock Size --------------------------- Wa Distance to nearest: Well ---------------------------------- ---Foundation -------------------. Prop. Line ..................... i i! REPAIR/ADDITION(Prev. Sanitation Permit# -------- ----------------------------------- Date -------------------•--------- Septic Tank (Specify Requirements) --- -- ---------- ----------------- -------------------------------------------------------------------------------------- .i Disposal Field (Specify Requirements) -------------------------- ------- - ------------------------- -- -------- �' -`- --------- -----------60--- !{ (Draw existing and required additi non reverse side) I hereby certify that I have prepared this application and that the work will be done in accordance with Son Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed 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 becomes b[ect to Workman's Compensation laws of California." it Signed --------- - -�,� ---------- -"- Owner Y ---------------- Title --- -----_Le-< ------OR— ---- --------- ---------------------- -- (If other than 'owner) 1; IFOk DEPARTMENY USE ONLY pp APPLICATION ACCEPTED BY ----- ---- -- -- ------ ---------------------------------------------- DATE Q_-- ----------------- BUILDING PERMIT ISSUED = ------------------------------------------- - DATE ADDITIONAL COMMENTS ';. € ---- -------------------------------------------------------- -----------•--------------- --------------------------- ------------------------------------- ----- ------------------------------------------------------- -----•- ----'-------------------------------- - - - --------- ------------------------------- -- --------fes Final Inspection by: - - ------------- -------------------------------------------- ------- .......Dated'_-�-----------� ,i . SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'66 Rev. 5M