SU0004821 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: i --------------------------------------------------------. APPLICATION FOR SANITATION K, IIT - (Complete in Triplicate) Permit No: __71-3-A- .7 __________ ---------------------------------------------- This Permit Expires 1 Year From Date Issued Date Issued .-7 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. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION'.n�q�_:»!-- f-- S-------041-Z-V F -----P11. -----CENSUS TRACT ._. ...... _. Owner's Name : '1_ R p f�J---------•- j' ► Phone ------- ,--- ------•---- Address ------------k=-0 B-OX---------33__tt—--------------------------------City _ ------------------------------------------- Contractor's Name -----apjk-:Jl;f_ _=--------=--------------•--•-----•-----------= ------ ------ ------ Phone ------------------- ---------- _ License_#..: Installation will serve: ResidenceXApartme.nt House-[] Commercial':❑Trailer Court ❑ f ; Motel ❑ Other - =--------------- -- + 01 Number of living units::.__ Number'of bedrooms ___.._Garbage Grinder _. Lot Size __ [-5 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,j] ;f Hardpan ja Adobe❑ Fill Material __4f 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 [,] SEPTIC TANK � Size___ _.j��___A------6--------.__ Liquid Depth ---- ...... Capacity I -- _,__ Type FF,9B Material COAtAl- No. Compartments .......Z 4- Distance o nearest: Well __�"} _ Foundation ._- - ___'" :__ Pro Line __.__: __" � LEACHING L . :.:_ ....... .. I p• _ INE: .. No. of Lines. ---_-2-- _______ 'Length of each line------- Total Length ____,1 _._....__ 'D' Box �� Type Filter Material - f��._Depth; Filter Material -------- ____________________________• Distance to nearest: Well �� - Foundation _j�_----------- Property Line. ___f�_______-j-_•--- SEEPAGE PIT Dept . _�__ ;��0 Number :------__ __ Drameter. �._ ______= Rock Filled Yes No ❑ j _;!__:7! ' Al ` -- _...... _�_ - ••----•--•--------.Rack Size' - Distance tb,nearest: Well -____ •_ -- ----. -- Water able Depth-, �_____ �� -- ---------------- --Foundation -��=--------- Prop. Line .... ` REPAIR/ADDITION(Prev. Sanitation Permit# --------------------------------------------=Da#e-=_-=-. ----------.--•--- tSeptic Tank (Specify-R'equiremen 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 Sun Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: "I certify t in'the'performance o the work for iVthisrmit is issued,.I shall not employ any person in such manner as to bec ubject to Workma ompensati I wfornia," Signed - tl» - j� `---- Owner BY - ------------=-----------------------•--- Title --------------------------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -------��_13,T_!_13,40--------------------------------------------------------------------------- DATE ---------- BUILDING. PERMIT ISSUED .•---------- -------•- _ _ DATE -------------------------------------- ADDiTEONAL COMMENTS _-- - --- -- ----------------------------- - -- --- ------------ ----- -- -- ----- - ----------------- ------- ----- - ------ ------------------------------------------- ------�--- i' = ---- --------=-------------- -------- -------- ----------- --------- -------------- --------------- -------------------- -------- 1 . _ ---------------------------------- ----- - r ----------------------------------------- Final Inspe -- - ---- L� ` --- --------------------------------------Date --------- --------------- SAN JOAQUIN LOCAL HEALTH DISTRICT i F U O 1.'AA RPA, 1-,AA ;'