SU0006288 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ''� - tPLICAT[®NmFa SANITATION $®N PEI��'�,T Permit No,. ----=---------------------------------------------------- p. Date issuedThis Permit Permit Ex ires 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 i -Complian a with C unty Ordinance N 549 and existing Rules and Regulations: J08 ADDRESS/LO N .r4�� - ----- -:- ---c- -- --- -- --- - - -- - -- - - ------------------CENSUS TRACT -------------- ----------- Owner's Nam - -------- ---------- -----------------------= Phone -------------------- •----- -------- ----- -- -- - Address /- --- �-------- ------------- -----•----- ------- - --- - ------ -- -- -----------. Cit �j� --- License # _� :_-0__`____ Phone --------•--------------------- Contractor's Name ------ -- - - - - - ---- - - --- - - --- �- -- Installation will serve: Residence A rtment House Commercial ❑Trailet Court 0 Motel ❑Other ----------------------------- -------------- Number of living units:___ ------ Number of, bedrooms ge Grinder ____ Lot Size ___• -------------------------------------- ._____.?°Garba - - Water Supply: Public System and name ------------- --•-----•-----------_..----------------- -- .------•------ --- -------------------Private Character of soil to a depth of 3 feet: Sand❑ Silt l] Clay .❑ Peat 0 Sandy Loam ❑ Clay Loam Hardpan ❑ Adobe-❑ Fill Material ------------ If yes,type ---------------------------- (Pl'ot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) LV NEW INSTALLATION: (No septic tank or seep a pit permitted -f ublic ewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK Siz �y -____ Liquid .Depth -------------.._____. Capacity _j_ --bC�PtWepl Tye ----- ----- ------ Materia ------ No_ Compartments - --;_--_-- i i Distance to near ------------aJr'-'d-------------------Found�o�-----r-A---.-------Prop. Line _..�:...------ LEACHING LINE [0] No. of .Lines ------3-------------- Length of each line-----------_ --------- Total Leilngth .___'... -_v----____..---•- 'D' Box -- ---_---- Type Filter Material ___ZZ_---Depth Filter. Material ....(_�--------------- ----f_...--__ Distance to nearest. Well --------�d------ Foundation /0 ___ Property Line, _____________ + SEEPAGE PIT [ Depth -------------------- Diameter -----------..__. Number ---------------------------- Rock Filled Yes '0 No .i0 WaterTable Depth --------------------------------------- --------Rock Size ---------------------------- Distance to nearest: Well ----------------------------------_....Foundation -----------:-------- Prop. Line ---_---•------.__----- REPAIR/ADDITION(Prev. Sanitation Permit# ------------------- -- -------------------- Date __---------------------------------) Septic Tank (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.t a following: work for which this permit is issued, I shall not employ any person in such manner I certify that in the perfor a of the wo as to become subject to W rk +s comps tito -laws of California." Signed ------------------------------ ---- N -- ----------------- -------- Owner By --------------------------------------- Title (If other than wnerl FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - '--- =-------------------=------- ------- ----------------------- DATE _ _ = ------------ a BUILDING PERMIT ISSUED --------------------------------- -- --- ------- DATE ------------------------•-------------- -- -- ------------ ADDITIONALCOMMENTS ----------------------------- -•-- - ---------------------------=---- --------------------- ------------------- ----- --------- --------------------------------- ------------------------------------------- ------ ------------------------------------------- ---- ---------- ------- 0--- .--------------•------------------------------------------------__& -- - -va-- ---- ----- - - Final Ins ection b _____ _ ._ Date ______ ________ P Y ------ SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M.