SU0006802 SSNL - Laserfiche WebLink

Home Browse Search

L FOR OFFICE US=: I ?PLICATION FOR SANITATION PER :20 Permit No. (Complete in Triplicate) / .- --. This Permit Expires 1 Year From Date Issued Date Issue., r P.pplication is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein L described. This application is remade in compliance withCounty Ordinance No No. S49 and existing Rules and Regulations: 0� . 7�- cS 0...-..'[`c...vt ..CENSUS TRACT _.... .r........-- JOB ADDRESS/LOC TION . . .... Owner's Name .... .... .. ................._...... - ......_-..._... .. .........- ............... . ^ 7 T Li C L Address ...OG J... _....... _ �� oD ."''--i lJ _................_.... -.-._....._.... n n q q / ...9... / ` Contractor's Name ... -rtl- - ...... ... ..................`.C..... icense # sL.�5 /,14. Phone L Installation will serve: Residence Apartment House❑ Commercial ❑Trailer Court Motel ❑ Other .. ----------- ------ ------------ ----- --- Number of living units:._.-.... Number of bedrooms --%Y...--Garbage Grinder .�- Lot Size .. 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 r-1Adobe El Fill Material ..... ._--- If yes, type ..........__........__.. i• (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) e within 200 etJ NEW INSTALLATION: X(N se P tank or [eJ T e it a iM �bf�s-. r is av1°rylo. squid Drtmth ... �- -PACKAGE TREATMENSEPTICK PSize. at COsZC�sc4 / q pP /� P 9 P P rapacity yPal L Distance to nearest: Well ..... -100___--,-_--------Foundation ...�D..-_..__-- Prop. lme .-r]N...-.-'...�.-_.. _ LEACHING LINE No. of Lines ....-._---- Length of each line.-.-.J�? --... - -- Total Length ._..�-�f\........-.----.- L 'D' Box _ .....-- Type Filter Material / a{ -_-_--- Depth Filter Material ----- -------- // De -...../—/0 . . . -. . Distance to newest: Well ./�9.i]....--.-.- Foundation -_-/�............. Property Line -----, - - -- ---- SEEPAGE PIT KI Depth ..._ p.-...--- Zict refer ��-X--rNumbe- _..--.._� ../....,.-.- Rock Filled Yes No :❑ U �� _ Water Table Depth _..._ ... t'/------ - - - Rock Size -- F--^ ----.:... -� Distance to nearest: Well . ...-...-../. Foundation .. ..Q...._------. Prop. Line ...-✓(............... ter,...--...¢_ -- - � L. 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: V "1 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 become subject to Workman's Compensation laws of California." Signed ... ........ Owner By ... 0 _.. Title .. LLQ ... ... (If other than owner) EPARTMENT USE ONLY DATE_ APPLICATION ACCEPTED BY ._ / C DATE // v! - BUILDING PERMIT ISSUED _. 1./" i ADDITIONAL COMMENTS L ... . _.-.