SU0004194 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: r •�-C.Ip-` �"/ r �-� Y �6r� rU 'PPLICATiON FOR SANITATION P "'T - ---- ---- --------- Ift'ftw - Permit No. (Complete in Triplicate) - -----------------_------ --------------------------- This Permit Expires 1 Year From Date Issued Date Issued --- Applicationis 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. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION __.__ �CC1V. P)000____&____t[d �___I_ _._--___-__. _ 2C� J. ___._ .___. CENSUS TRACT ----rS__S-_----------_. Owner's Name ------------------------6PI9PT I-------------12-J( -'�' 14 -7 Phone - ---------------------------- Address ------ -- --�-3----•------------------------------•-------- Cit ---- -- X12/U - ---"------------------------------------- ---- Contractor's Name ------ --------- ---------------------------------------------------.License # ------------------------ Phone ------•--------------------- - Installation will serve: Residence ❑ Apartment House Commercial ❑Trailer Court ,❑ Motel ❑,64her ---- ---------------- Number of living units: __-- Number of bedrooms ---lz__.__Garbage Grinder ----- Lot Size --------Z21P.A________________________ 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 ❑ Adobe 0' 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,) �Q PACKAGE TREATMENT [ ] SEPTIC TANK [ Size___. O/t "- 1-------------------- Liquid Depth ___ --------------- � --__ No. Compartments _-._�------------- Capacity _1�fJ. __ Type �-Com.---- Material_�'CSk_.__. Distance to nearest: Well _.._ _____ ._-._-------- -----Foundation --------- - -- Prop. Line _______-_____------ LEACHING LINE [ ] No. of Lines __ - Length of each line-__ __ .- Total Length -----------_________________ 'D' Box . - ._ Type Filter Material ----- --- .. ......Depth Filter Material ____.__..._-...__.-___-___._------------ Distance to nearest: Well _ -----------<---.____.Foundation .___ -------- Property Line .._ ------------------- SEEPAGE PIT Depth teeter��x/5_ Number __ __ ____._. Rock Filled Yes 2---No 11 Water Table Depth ----------Z.0--------- ----------------Rock Size �------0--------------- V 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 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 ak to become ubject to Workk I Com-;;� ....pensation laws of California." Signers I ------ � ......................................... ---- ------------------------ . . Owner BY - -- - - ------------------------------------------------- -- Title . - - - ------------- --- --- (If other than owner) FOR DEPARTM 5 ONL APPLICATION ACCEPTED BY --------- --------------- ------ -------------- ------ - DATE --- - - -•-- ---•-------------•-- - BUILDING PERMIT ISSUED ________________________________"_____ _ •- -- ---------- --------- ------ ----- --- ------------ DATE ADDITIONALCOMMENTS ------------ ------------ - ----------------•----•-----• -----------------------------=----------- -------- -------•---• -------- ----------------•-------------------------------------------------------•------------------- ------- - - ---------------------- ------ ---- Final Inspection by: Date - - --- -------- SAN JOAQUIiv LOCAL HEALTH D ICT E. H. 9 1-'68 Rev. 5M