SU0006791 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: (-APPLICATION FOR SANITATION PE 7 � , c Permit No. J - --- - (Complete in Triplicate) p bate issued ---------------------------------- - - ------------------------ 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. 5.49 and existing Rules and Regulations: CENSUS TRACT --- j JOB ADDRESS/LO N . -------7-911--- ----- .. -- ------- ------ ---- - - Phone -------------_:-------------------- Owner's Name . -- ---------------- - Address - - Q �` City a Contractor's Name --------______________ --- --------- -- --------------------------- ----- •- '�---.License Phone ------ -----------••---------- installation will serve: Residence Apartment House❑ Commprcial []Trailer Court Qd Mote! ❑Other - —- -- - - Number of living units:------------ Number of bedrooms -----------.Garbage Grin er _____--_____ Lot Size _-_______________ __ Water Supply: Public System and name ------------ ------------------------------------------------------------------------------- Private ❑ ----- ------ Character of soil to a depth of 3 feet: Sand'❑ Silt Cia ❑ Peat❑ Sandy Loam ❑ Clay Loam Hardpan ❑ Adobe-K 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 see age pit permitted if public sewer isavailable within 200 feet,) +� o O PACKAGE TREATMENT [ ] [ --- Liquid Depth -- ---------------------- SEPTIC TANK' Size- '._'_X _. '_- --------------- a Ca acit 114 Type ------- ------------ Material---------------------- No. Compartments --------- ------- Distance to nearest: Well --- h e __.-r- a /No. of Lines ------- ---------- ---- Length of each IineFound iia-- -------- Total Length Lin G' r LEACHING LINE [�Y - #� i� 'D' Box ----- Type Filter Material ______ _ _-__Depth Fitter Material Distance to nearest: Well ___ ------------ Foundation ------ --------- Property Line. --_F^---__ _ -- - SEEPAGE PIT L Depth __C� Diameter ------. Number ---------- --------�---- �, ,,Rock Filled Yes '� No i❑ ��-- _ r Water Table Depth -------------- -------------------------- Rock Size ------ ---- i Distance to nearest: Well ----------------------rI---------Foundation ---J_Q- Prop. Line --- --------------• REPAIR/ADDITION(Prev, Sanitation Permit# -------------- ----------------------------- Date ---------- ) ------------- Septic Tanks(Specify Requirements) - ---- -------------------------------------------------------------------------------------------- ------------ ------------------------ ---------------------------------------------- Disposal Field (Specify Requirements) -------------- ------------------------------------------------------ --------- ---------------- --------------._ ---- ---- -------------------------------------------------------------------- -- ----------------------------------------------------------------------------------- ----------------------------------------------------- (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 become subject to Wor an's Compensation laws of California." Signed --- ------------------------ 07 ---- --------------- Owner a� ----------------- -------------------- --------- T itle _ --- --------------------------------------------- By -- ----------------------- - ---- (If other than owner) FOR DEPARTMENT USE ONLY I APPLICATION ACCEPTED BY --- -------------- --------------- -----------------------------------. DATE `�'a`I ---------------------- BUILDING a -----------"--- ' BUILDING PERMIT ISSUED ___-- ------ -- - ---DAT --------------------- ----------- --------- - --- ---- APDI IONAL COMMENTS - --------- -------- -------------�,_-------------- -------------------------------------------- ---------------------- ------------------------ X ---•------- �i,.' `tea �� ...... �� --------------------------------------------- --------------------------------------------- ' --------------------------------�"-------- ------__ -- -- ------ ----------------------------------------------" ------------" ------------ ____ - --------- --- ------------------- --------- ------- -------- - __ ---- --------------------- ___ Date Final Ins ection b ----- ! C(1 - ------ ---------------------------------------- 1 JUIN LOCAL HEALTH DISTRICT E, H. 9 1-'68 Rev.