SU0012062 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: -. � Y APPLICATION FOR SANITATION PERMIT ............................ (Complete in Triplicate) ..........I.---... ......... .....................-7. �! Permit No.�.Z:_3.S_'> -------------- This.............. This Permit Expires i Year From Date Issued Date Issued ..T... .�.� Z Application is,hereby made to the n oaquin Local Health Districtg4or, a permit-?o construct and install the work herein described.This application' id made In mplionce a No)50,.and �kiftingi.�tµlis,;and Regulations, JOB ADDRESS/LOCATION ClR ._ `__ : . . . _ . __ - _------..._._ LiM ,....CENSUS TRACT ...._... - Owner's Name .fv.t..--l ...hit.E.V?A.MiDA./...�..P♦�,E1.P-C/Ott~T/ES...............Phone 1%XZ67-.L ,317.....-.. Address e F�'1:l�1�.._ aJ + `r •'•O OQCity �f. M_.... ..... ................................... - ,/ Contractor's Nome_ ..P _� _ ._.--A,__. �.p�/ .....:........License #/ VS.7�I___ PhoneYG FbQ..7-_- Installation will serve: Residence❑Apartment House❑ Commercial❑Trailer Court Motel [I Other------ - I Uzi ;t 1 ) . Number of living units �:�. Number of bedrooms a5.......Garbage Grinder .NO.:. Lot Size .A.C.AEA6___4_-.......... Water Supply: Public System.and name ............---------......-.................----------._-....--............M........................ ------Private Character of soil to a depth of 3 feet-.rolian 1 .►Silt❑ '<Clay ❑ Peat❑ Sandy Loam ❑ Cly Loom E] r �, .- .Hardp-V ❑ Adobefft Fill Material ............ If yes,type............ --------------- I (Plot plan, showing size of lot, location of system in relation to wells, buildings,.etc..must_be.ptaced on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) C PACKAGE TREATMENT [ I SEPTIC TANK Size4X /.Z7s��.e�.7�..�...y} ;�_�- Liquid Depth Capacitya41ftp__...- ��n------•---4•--- • Type�..�....'�rMaterial.l,..777'WtLCC. No. Compartments Cz�)....... t 41 I .4 y Distance to nearest: Well ._fJ ......................Foundation -Q.------------- Prop. Line 3�0. ...... LEACHING LINE � No.'of Lines ----3............... Length of each -. .- Total Length L \ 'D' Box 0J.-0J.- Type Filter Material �.3xQKK..Deprh Filter Material .�..1...rr....................... .-_.-.- Distance to nearest: Well I60.............. Foundation oma. L.............. Property Line'-700 SEEPAGE PIT Diameter ................ Number ..........................._ Rock Filled Yes No [ ] Depth -- --- ------- ❑ t7 Water Table Depth -.............-...... - ....-;r7lock S-30 - ------ .................. Distance to nearest: Well .................................I......Foundation .................... Prop. Line -..................... REPAIR/ADDITION(Prev. Sanitation Permit 94 .... ...':..'_^?'1:.>_.+.# Date .... ..........._.__._____..) Septic Tank (Specify Requi'rements) - �r.\�-.(-�t-.�.' Ct' . t +-- Disposal Field (Specify Requirements)_'-".`-- ------------ ------! :- - - ------------------ ------------ --- - ---- - ................. - -- - - ....:.. .......�- -- - ---------- ....... -------- -----• ................................... -----......--- - - ..................------- . ...... ......... _ _ . . --------------•---------------I....- ---_.._... . .1------------ -------. .__...--- - -- .. ...... . (Draw existing<and.required}addition on rever;e side) I hereby certify that I have prepared this application and thatrthe Work will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the Son-lbef frill-local Health District. Home owner or licen- sed agents signature certifies the following: "I certify that the e�nce f the.work for..which this permit is issued, I shall not employ any person in such manner + as to heco su ject to,W man's Compensation laws of California." Si Bed?.... T �/� � ) - 1 ,_• Owner y V. - -- ...._...... J;:. Title .r ohan owner / o r. :.. . FOR .DEPARTMENT USE ONLY / APPLICATION ACCEPTED BY)---------- ---------r.-�---------..z...-...-.--. ...-. ... DATE .... : .3.1.�Z BUILDING PERMIT ISSUED :_:.. .---- --- r t -- -;: :.DATE .......'-` '.: ��: T---••-•_ a ADDITIONAL COMMENTS --- - .......- ----------- 1... - --- .... - -- - -- ..... �. s .. ------------------- ----- i------- - - t ... - ----......... . I ----------- - ---_---------- - - -.- - - ---- - - f ... ; e, Final Inspection by: _ 111' ^-- - -----------�`-------- .......... ....:.x..........----.......-----.Dare .... ..L.J�.--- --.7..Z........----------- e .SAN JO)QUIN LOCAL HEALTH DISTRICTVAS, '0C1 a 1. 9 1-'68 Rev. 5M s.