SU0006712 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: PPLICATIION FOR SANITATION - ---------- Permit No. --------------- (Complete : __---.(Complete in Triplicate) ---------- ------------------- -------- This Permit Expires 1 Year From Date Issued Da a Issued -- ----------------- ----------- ------ - ------------------ i Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein described.T is applica ion is made in compliance with County Ordinance No. 549 and existing Wei and Regulations: JOB ADDRESS/LOCATION .-.-2 a- S1 .-------H W_IX-----' - ---- - ..........CENSUS TRACT - � Ei>---------- M. -L-- 1--------------------------- ---.Phone.-'------------------------------ tqName ------------ ------------ ------ - .. Address 6's --------------------------------------•--. City _ _ Z-R-N y-----C-�---- Contractor's Name ---,-OWN SR------------------- ------------------- -- --------------=-------.License # ------ --.---------- - P e C)p - Installation will serve: Residence ❑ Apartment House❑ Commercial ❑Trailei i Motel ❑ Other -------------------------------------------- � r Number of living units:._._).'_._:Number of"bedrooms ---- ------Garbage Grinder -I_Y-C,---- Lot SizeC�----•--- Water Supply: Public System and name ------------------------------------ =--•------------- ------Private P -- Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑` Sandy Loam Er Clay Loam ❑ Hdrelpan-❑ Adobe ❑ Fill Material -_ If yes,type ----------------------- ---- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be plated on reverse side.) NEW INSTALLATION: No septic tank or seepa a pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ SEPTIC TANK S_ize___" X - q - Depth l b-X�-- -- ----i---- Li uid i Capacity Z� __.-- T eP &�C-�'s�T�TVo.�_Compartments -___--�:---- p Y � -- -- -- Yp ��f�ST Material Fo- , Distance to nearest: Well -_- ;_--------------------Foundation _,___a----_---__ Prop. Line __�.________------ LINE [yYNo. of Lines ------ ------ Length of each line___ - ____ Total Length ------ ---------------- LEACHING Ii._ 'D' Box/Y ._ Type Filter Material ROCK- filter iMaterial� ___ l __ _________________________ Distance to nearest: Well ------ -------- .Foundation--- �----._ Property...Line -- ------------------- - EPAGE PlT [l_7"°, Npth ------------ 'Diameter Flumber -- -- Rock Filie Yes ❑---No Water Table Depth -------------------------------------- --- + Distance to nearest: Well -----------------------------!=}- Found6tion ___ Prop. Line ---------------------- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------- Date ----------------------------=- -- _) :: ,f-, Septic Tank (Specify Requirements) -----------------------------------::_ = _ = is 1� :, hf_&� /j Disposal Field (Specify Requirements) ----------5- (�!�------tM ------ - {-�1---'------ �"i45 �gL g. .rARM------ VJOIRKER_----------'��.R-V----------------------h------------ M - is :.-- - __-____....._----.._________________________ ___ ____ _ _________--------'________,_____- --------------'I _____-_________-._____ (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 Sart Joaquin County Ordinances, State Laws, and Rules and Regulationi of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: "I certify that i the performance of the work for which this permit is.issued; 1;shall not employ any person in such manner as to become ubj Z ark an$ Corn ens tion laws of Caiifornia. Signed ------ - > /---- --------- Owner BY ------------ ----------- ----------------------------------------------------------------- '=--------- Title -----------='--------------- ---- ------- ----------------------------- (If other than owner) FOR .DEPARTMENT USE' ONLY APPLICATION ACCEPTED BY ----- -.___ DATE ____ " O BUILDING-.PERMIT,ISSUED._----------------------------------------------------------- --------------------------------------------DATE__-- --------------------------------,-- ADDITIONAL COMMENTSy T :) r ----------------------------------- - ' .._: -��------ r --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- FinalInspection by: ---------------------------------------------- -----:---------------------------------------------------------------.Date ------ ----------------- ------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT G2i` E. H. 9 1-'68 RevMb