SU0009533 - Laserfiche WebLink

Home Browse Search

FOR OFFICE SE: — APPLICATION FOR SANITATION POtMIT (Complete In Triplicate).............................. ......................................................... This Permit Expires 1 Year From Dare Issued Dare Issued "�ifc.7C Application Is hereby made to the San Joaquin Local Health District for a permit to construct and install the work here described. This application Is made In compliance wi my Ordinance No. 549 and I�x sting R Igs_gnd Re IoflonEv/{( JOB ADDRESSAOCATi �17 ,l aa? �� / L mc+..d i/ �" ' !.r.. .. /1CLYr..........................CENO TRACT ...... -..._.._.. Owner's Name .......... - t - .....................Phon. ...� Address ..................... - .......... .......City —64,4w .r �..........................-.................._. Contractors Name . ..t.a -Mn rr�'a...._. 5 .. sT,�... ..Ucense# ........................ installation will serve: Residence(NAparlment House{]Commercial C]Tralter Court Q Motel Q Other....................•----- .........- /J Number of living units:..... Number of bedroorrts�......Garbage Grinder ..........P. Lot Size (,l.Stznx�.�. ................ Water Supply: Public System and name _...........................__.._.__..... ----------_.:......_..............................._.........Private Character of soil to a depth of 3 feet: Sand C] Silt❑ Clay ❑ Peat❑ Sandy Loam C] day Loam 9C Hardpan B Adobe R!;�Fill Mcteriol ............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 ..............._ Capacity ... ..... -------- Type -------------.- Material....................._ No. Compartments ... _r Distance to nearest: Well ....................................Foundation Prop. Line .. _.... LEACHING LINE [ ) No. of Lines ........................ Length of each line............................. Total Length ..................._....... %A •D• Box ............ Type filter Material ....................Depth Filter Material ..... ......................._............. • Distance to nearest: Well ........................ Foundation ........................ Property Line ........................� SEEPAGE PIT [ ) Depth ............._...- Diameter ... ............ Number ........ .... _... ........ Rock Filled Yes Q No 0 Water Table Depth .......... .........._......._................Rock Size ............................ Distance to nearestr Well ..........-...........................Foundation .................... Prop. Line ........ REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date ......................... Septic Tank (Specify Requirements) ....A&._..._.._.-• ................ 40 � Disposal Field (Specify R irements) Pic e-t �- ...--. Px.•---..Y - .................. ..... ..... ......................... ............ ................................---.......----•----- ...................................................... ............ (Draw existing and required addition on reverse side) I hereby certify that 1 have prepared this application and that the work will be done in accordance with Sen Joaquin County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local Health District. Home owner or licem sed agents signature certifies the following: "1 certify that in the pe once of the work for whichth s ormif is issued, 1 shall not employ any parson in such manner as to beco subie/�{� on•s C�op/npensat n laws o Ca oroia:• . ......... Signed By ..............._.. ._5,1.`.:.....:.(.L,1n-K.•F;._.. pwgec ..... . ...................... J.. (If other than owner) FOR DEPARTMENT US ONLY APPLICATION ACCEPTED BY .._ - .-- DATE ...._... _....._-. ......... BUILDING PERMIT ISSUED .... ......... .DATE ........................................--. ADDITIONALCOMMENTS ..._....._......................... ... ............ . ---..........-.....--------- ------.---------- _. ---- ..............,:.................... .....- ............................ ......................-----...... .....--...._.................------......---........................----- ........ .. ........---....................---.......... ............ . ....... -- ................ - - ---------------- ................ .....-.............................•.......----..... ....... ...._...................------ ......... Final Ins ettion b ......_.............. ...._..Date ... + EH 13 24 1-68 pRev 4 SAN JOAQUIN LOCAL HEALTH DISTRICT 874 $cit