SU0003870 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE:y f.-i11 FOR OFFICE USE: -5- �.PPLICATION FOR SANITATION PERMIT 1-00, �7 /� 1 = #----- ---- -- (Complete in Triplicate) Permit No..7- - �f? _ ...._ -- Date IssuedS : '7.y ............ .................._----- ._-..__-_..._ 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 and Regulations: JOB ADDRESS/LOCATION. Xhl �/� .------- 'eq'y -/ CEN -TRACT. _ Owner's Name.:.- ty_-/ -S�rl --- --- -Phone .4�97-7fy� Address - lQ_1�� 4.�t2A1/<J/ Ci t .Q?aahynN -Zip -- ' - ' Contractor's Name - ____�.�.J�rf+�e✓SefF f •�$ -PKC.- .....License #.%LX�------Phone_.'��..-`/. ��f Installation will serve: Residence Apartment House[] Commercial ❑ Trailer Court ❑ Motel ❑ Other------------------------- -------------' , Number of living units:.--- Number of bedrooms_.,__.Y-Garbage Grinder------_----Lot Size.Ace'i O-9-10__. ..__------------------___. Water Supply: Public System and name---............. ..--------------------------------------------------------------------------------------Private $� Character of soil to a depth of 3 feet: Sand ❑ Silt❑ ' Clay ❑ Peat❑ Sandy Loam_ Clay Loam ❑ Hardpan Adobe Fill Material--------__If yes,type.______.._._._..__....... (Plot plan, showing size of lotlocation 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 [ 1 Size-----------------------__. -------------------------- --Liquid Depth----_____--------____S s Capacity,...__----------Type------------------Material---------------------_No. Compartments------------------------------"�) Distance'to nearest: Well_--------- --- ---__-------._------ ----Foundation_ ------------------ ---_Prop. Line___------_.______.__OT LEACHING LINE [ 1 No. of Lines----- ---------------------_Length of each line__----------- -------- -----Total Length__.__..__.___.____...._...__ 'D' Box. .......--.Type Filter Material........------------Depth Filtpr Material. __. ------------------------.----------------------- ------- Distanceto nearest: Well __._...__......._.....Foundation_----_,_-----------------Property Line---- ----------------------------- L p G ter____.............Number______._-.___._ _ E] No ❑" SEEPAGE PIT [ ] Depth_..____.._... Dian? _ _ _�,__..__.; Rock Filled Yes WaterTable De th.----------------------------------------------------.Rock Size----- -- - ----------------------------- - Distance to nearest: Well _ ----------------_---------------------Foundation--------------------------Prop, Line__..._.__.__-_-.._.._._� REPAIR/ADDITION (Prev. Sanitation Permit#_.____. ---------------------------------------Date--------------_____________._-____I Septic Tank (Specify Requirements)----- RC `--- -- --- ----- - - -------'---'----;------ - `--i-----..._------------------------------ ---• -----------------------------------I Disposal Field (Specify Requirements)--- fQ - - - - - DL-a-------- - -------- - --------------------------------------_------------------ +�-,'---]�.c�- ---- ----- dip / -'- -- ------ ---------------c--- ---------------------------------- (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 licensed agents signature certifies the following: "I certify that in the rformance of the work for which this permit is issued, I.'shall not employ any person in such manner as to become ub[ect orkma 's Com ensation aws of California." Signed--_J _FQs' - -- - -- - -. ...._....------ ------------Owner tJ By-- ------ .......-------- -------------------------------- - Title --------- ----- --------- (If -- ---- (If other than w DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- - ------ --- - -----------------------------------------.. DATE.--- --- 3 - ------------ DIVISIONOF LAND NUMBER - -- - - ------------------------------------------------ DATE------------------ ----------------------- ADDITICNVAL COO7MMENTS�--7-- --- - ----- - ----- ------------------ - - - - - - -----t�`--3��/-----------/--r-- y-- ------- �-��- ----- F--is3---'--foam-`------ - --- --- -"---- --------------------------------------777----""_---- .. ...__ ___ _ _._- .io.r_�-_._._ _ .,.ye�.._/.f......_/1y7------ .y_ y,-};N.___�..-------____..__ _..._..._________________________--_---------- ---- __..__ .-________.__.-___..___.._.._._____...._..._......_._._...._._____..___----- Inspection by:----'--- '----- - f - =Gr - ------------------ -- -- ---------------------Date------[-- - - - .._. . . - - - - ---- - --- - ----- Final - EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F 21677 REV. 7/763M