SU0007974 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION Plrt {Complete In TiIplicatel O This Permit Expires 1 Year From Date Issued asued '• .".�... .�e 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. 5$9 and existing Rules and RegukMons: JOB ADDRESS/LOCATION �0-�� . C��- CENSUS TRACT................... �.Owner's Name ..._. phone Address . ............. ..Ij... -. .- 5.7 City .. . .`.... . ... .........................._........................._ Contractor's Name ....... -. c _ ., !?_.%Liemse ih Z�'- 7A.... Phone .............---......... Installation will serve: Residers Q ApartmentHouse a Commercial OTraller Court Motel 0 Other —'Ai.. .—. Number of living units:......-•---- Number of bedrooms ............Garbage der ............ Lot Size .. ----...... ..... ...>� ~ .............................................. Priv.........._......... Water Supply: Public System and name Q .... .Private❑ � Character of soil to a depth of 3 feet: Sand D Silt 0 Clay ❑ Peat 0 Sandy loom Q Clay Loam Hardpan❑ Adobe fl Fill Material............ If yes,type............... ............ !'s {Plot pian, showing size of lot, location of system In relation to wells, buildings, etc. must be placed on reverse slde.) NEW INSTALLATION: (No septic tank or seepage pit permitted If public sewer is available within 200 feet,! PACKAGE TREATMENT [ ] SEPTIC TANK f ] Size................................................ Liquid Depth ........................... ' Capacity .. Material...................... No. Compartments • Distance.to nearest: Well ....................................Foundation ...................... Prop. line ......__. .............. LEACHING LINE [ ] No. of Lines -....................... Length of each line................._. —...... Total Length ............................ '17' Box _.....-_-... Type Filter Material ....................Depth Filter Material ............................................ Distance to nearest: Well ........................ Foundation .............. ......... Property Line ......................... SEEPAGE PIT [ 1 Depth Olometer ................ Number ............................ Rock Filled Yes ❑ No C3 Water Table Depth ..---•.....................•--..............._..Rode Size ................................ Distance to nearest: Well ........................................Foundation .......... Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit�# ---.-.-............................•..--.... Date ..........._..........._....... .) ........, Septic Tank.iSpecify Requirements) ........ .................... ....................................... ............... Disposal Field (Specify Requirements) -. . cam_•.- .__, _�_-�- - - -..-----•----- ------------------------.....................-..............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 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 worts 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 -----------•-•-------------- ------------- Owner By....-................... r .. ... ......... . ilio �._...__. ---------------------- (If other than owner) FOR DEPARTMENT t15E ONLY APPLICATION ACCEPTED BY.__if-43-p-(_._. .. -----•---•------••........................_ . _............_......._........ DATE . . . _. C_.... BUILDING PERMIT ISSUED ...................... ............---...........................--- ................................... DATE .......--------------............. ..... ADDIT ZONAL COMMENTS ...................-•-••------•---•_-_...-•------•--------••---...�..----••-•--------------------- ...--•---•-------•--•---•--.. ................... ---- -------------------...--------........................._........._...---...-._-._.-------------•---•--...........-_........._.I.._...__...__----•---------- ..................................._...._.. _ -----... ---------------------------------------- - y� _ _ Final inspection by: . � - -------Date j...... ._'x....... ........... ...• EV 13 2h 1�if3 I3ev. $Yi SAN JOAQUIN LOCAL HEALTH DISTRICT 8�?4 3i1