SU0004908 SSNL - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: :PPLICATION FOR SANITATION PE' 'T (Complete in Triplicate) Permit Na. ..71Q - -----.- ---- This Permit Expires 1 Year From Date Issued Date Issued _1x-.30,_7J 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 and Regulations: JOB ADDRESS/LOCATION ..awo_-- -.PCW�_L\:--- \�-----....---- -------....---- ----- _..--------.CENSUS TRA,CT ..5AR/ --------- Owner's Name -- --. ?r-I4Z,_C --------------------------------- ----...--`----.Phone .11" �i .�C2�1J----------- AddressS 2'3c------------------------...------..--------------------------------------. City ------------------- ------------------------- Contractor's Name ...St-,.F-- -------------------------------.License # ------------------------ Phone Installation will serve: ResidencegApartment House❑ Commercial ❑Trailer Court C1 Motel ❑ Other - Number of living units:-- Number Number of bedrooms .�----Garbage Grinder kAd_.--_ Lot Size .�IVtS-------- Water Supply: Public System and name.. -- ------ --------- - _.Private ---------------------------------------------------------- .-.. - Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam r 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 X SEPTIC TANK Q I Size----------- ._-_------ ._...._..___ Liquid Depth . --------------------- Capacity 1aOOGOJ Type f2 �(LtT_. Material No. Compartments a----.-_.._..__ / Distance to nearest: Well -��.-_-----------_ ---- ---Foundation _.- Prop. Line DD_-,�_7.,,5_-.._.-..___ , LEACHING LINE pCf No. of Lines �_ _ ___ Length of each line____.Iv_______ Total Length _.ILy✓._.._._-_.----__ ✓ 19- 'D' Box __. .-.. _ Type Filter Material .1t�.-IwSr��Depth Filter Material ....__ _:"F--.-_-.--__-__._.__.. i .� Distance to nearest: Well ..� - -------------- Foundation --------- ---- Property Line .501.............. 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 --------------------------- --- _I Septic Tank (Specify Requirements) ____ --- -------------------------- Disposal Field (Specify Requirements) ------------------------------ r ----------..------------------.-----------------------------------------------------------------------..........---...--------------------- (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 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 beco sub�je„c} to W/ rkman's Co tion laws of California." Sig ned;ate f�.----{�-F------------ - Owner By - -- ---- ----------- --------- ......-- ........ . .. Title (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------------ --- ---------- - - -------------------- - --- -------------- DATE ------------------------------------------ BUILDING PERMIT ISSUEDDATE ______.... ........._..........._-_ --- ------------- ------------------------------------------------ .. ADDITIONAL COMMENTS I:��1� - -- - -- - -- .............. ----------------- ------------------ --------- - ----- ---------- _......... -------- - -- -- - -------------- ----------------------------- - - - - ----- - ----- ------------------------- ---- ---------------------- - - .._..__. ---- --------- - - -------- --- _ -- -- ----- Final Inspection b --__-- ._ Data _.- . '- � -- - - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M