SU0003507 - Laserfiche WebLink

Home Browse Search

Foy OFFICE USE: ppp�E�ATEON FOR SANITATION MET .........------•----............ -- -- ----- Permit No. (Complete in Triplicate) ............ ------------------ ---- - --- - GG /3- 73 ----------- This Permit Expires I Year From Date Issued Hate Issued ---(F------------- , Application is hereby made to the San Joaquin Local Health..District for a per to construct and install the work herein described. This application is made in compliance with County Ordinan a Pa. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ----4' u CENSUS TRACT __. -`,-�.------..... ,�= , Owner's Name ----- -----�--= s - - -------------- ---------------- - -------------- - - - Phone ------------------------------------ c Addressd pi ------------- --- -- --'-------------=--------------•--. City .r� /. ✓_ ---------- •-----------------------........., Contractor's Name -----/ejp/a. / � ---- License # /fv�.. �hd7t -------------------- Installation will serve: Residence ❑ Apartment House,)] Commercial❑Trar Eft ' Motel ❑ Other .----,-e-�---. ----------:---------------- Number of living units:---/----- Number of bedrooms _-_;Z.....Garbage Grinder _/��`... Lot Size�'f!`, � _ _____________ Water Supply: Public System and name ----------------------------------------- -----------------------------------------------------------.-------•-Private, Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ 'Peat ❑ Sandy Loam ❑ Clay Loam ❑ rl-ga,JHardpanX Adobe ❑ 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 seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT SEPTI STANK' Size._ f � l -�-��•s�� -• ----------------- Liquid Depth . ..._.....------- -� Capacifi / Type Material.epd%ec�_ No. Compartments ......:...... Distance Barest: Well ._______ . _______________Foundation _. __........__ Prop. Line ....__..__......__ \Y/ LEACHING LINE [ No. of Lines ._ _.._.____.'___._ Length of each line_ ��,,�'-------- Total Length / ................ 'D' Box /-V-67- Type Filter Material /1'tX_ .r4&Depth Filter Material /1!Y_. . -_ _ j - ' '01f Distance to nearest: Well --- -Y---- ______ Foundation _ - -_._____._. Property Line ................ SEEPAGE PIT [ Depth --------- Diameter Number .......9^---------------- Rock Filled Yes )' NO Water Table Depth ------10polf-_-----•------------------------Rock Size -�- -�--•--......_..... Distance to nearest: Well __ _______________________Foundation ._�L �_.__ Prop. Line/�� a....__.. 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 1 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 Workman's Compensation laws of California." Signed -------------- ----- - ------------ j- ----------------=------------- Owner B 6 Title � .. Y (If oche an owner) FOR DART ENT USE ONLY APPLICAT10N ACCEPTED BY ---_ - ---- -_ - ---------------------------------- DATE _ `.:_ BUILDING PERMIT ISSUED ------ --------------------------------------------• ------- -------------- .... -----------------DATE . ---- •--..._ •----------------- ADDITIONALCOMMENTS --------- -•---• ------•----•-------------------- •---•---_-_-_--_..__•.---------..----.-....__...---------------------------------------------•-------•-------. ------------------------------ -------- Final Inspection by: .- Date Q-_ ' �W ` _ SAN JOA:4UV LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M ��