SU0006046 SSNL - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APP' KATION FOR SANITATION PERMIT 7` � -3 _ (Complete in Triplicate) I-W Permit No. --- --- --- Date Issued ..�-/1 '77 --. This Permit Expires 1 Year From Date Issued _ .. implication is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein iescribed. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: 1 B ADDRESS/LOCATION . ... �� l �_ ....� -1?_. �C� __ _. .__ ........ CENSUS TRACT ...---- Dwner's Name .......................... .........Phone .................................... dress t):. O... ,.. . . - -c - City � -.0� 't7ntractor sm � License # 1 Phone ------------ ................. n�tollation will serve: Residence Apartment House�❑ Commercial ❑Trailer Court .❑ _ Motel ❑ Other .. .._.. ........... ........... ^ dumber of living units: 1 Number of bedrooms ._..Garbage Grinder Lot Size ..__Ce �s o\ ...... . --•------•-------- v iter Supply: Public System and name ----------------- -----•--------.... ..•----_.. . .... -_.. . --- --------......-- . . ---•-------------.Private [�}� :.'Marocter of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam K Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material .... .... If yes, type riot 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,) CKAGE TREATMENT SEPTIC TANK Size. T�-_-_l ( � i � x--•------ �� Liquid Depth .......... Capacity I p-t c AA Type Material., e- _.. No. Compartments _1-.31.............� Distance to nearest: Well I� d ...._..-Foundation .� C�_'�....... Prop. Line . =ACHING LINE (tj No. of lines Length of each line fir. " Total Length _-�.a��.. .............. 'D' Box Type Filter Material ----—'_.J�_.___...Depth Filter Material _ _).el_............... ---------------- _ Distance to nearest: Well - - - _.�.b.o-- --- --- FoU-ndation- � ts..�t-. _. Property Lit'►e-.::.�- -------------- SEEPAGE PIT (,V Depth r Diameter .... Numbe- . .... ct3 Rock Filled Yes E____�No Water Table Depth ----- Rock Size -~ Distance to nearest: Well _. _ t-0-__. ...............Foundation �.n-. ..._ Prop. Line REPAIR/ADDITION(Prey. Sanitation Permit# --._... ... . .... ..._..__._.__-._.__ Date -------- ................... Septic Tank (Specify Requirements) __-. _-_._............. ........................................ Disposal Field (Specify Requirements) --------------- --------------- --- -- _ -- ........ -- ..._.._._ ---...... .. ...... ................. -------- --- -- ---------------------- ----- _.. . _ _ ... (Draw existing and required addition on reverse side) ereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin unty Ordinances, State laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen. ced agents signature certifies the following: certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner to become subject to Workman's Compensation laws of California." ,ig ne � _.-.... n ------------------------ Owner Title (If other than owner) FOR EPARTMENT USE ONLY PLICATION ACCEPTED BY C• _ _ DATE t1 /` _ GILDING PERMIT ISSUED ADDITIONALCOMMENTS ..........---------------------- ...........-.._........... ....-_........... .-- ----- .......................... ............. . ... . --- -- ------- --.._................. • ------. --._..... ..--- . . ----- ......... -........ ----- - --.--. ------ ------------ .......... _.. .. ... .................... ...................... ._.__. .... _.........-----...... ....... . ....----..... •-• .......-- ................................ final Inspection b .................Date . . . SAN JOA QUIN LOCAL HEALTH DISTRICT