SU0007898 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT p (Complete in Triplicate) Permit No. -- ----- . - ---.----- This Permit Expires 1 Year From Date Issued Application is hereby made r. ......... Ap P y de to the San Joaquin Local Health District fora 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 .. CENSUS TRACT .. ._------ Owner's Name - at-C-O Ph -_ ------- -- ------- one Address . - 1 �� . f - Cit 6 c - . a ------•----------------------- Contractor's Name -------- ............. ..I. ----- '-SQy�Q/---_ -_--- --_- License # __. .. __ Phone 5'x.6--96----L5 -7- Installation will serve: Residence ❑Apartment House[] Commercial ❑Trailer Court Motel F1Other._�r_AIL---�-�1. . S ,a'tsa� Number of living units ... Number of bedrooms .._.Garbage Grinder ..._._ - Lot Size _ - -----------_ Water Supply: Public System and name ---__________-_-__. --------- Private Character of soil to a depth of 3 feet: Sand b Silt❑ Clay E] Peat❑ Sandy Loam' Clay Loam ❑ Hardpan ❑.- Adobe [] 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.) g NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK'[ ] Size---__--------------_- - __---------_- Liquid Depth ......_____-_---___,____r Capacity ._ ____ ____ --- Type ------------ ------- Material----------------- No. Compartments -_.................. . Distance to nearest: Well -------- - _ _ ------------_._Foundation _ _ _-___._- _- Prop. Line ______________________ LEACHING LINE [ ] No. of Lines ___. Length of each line ........... ............. Total Length \n 'D' Box ------- __ Type Filter Material ........------ ----Depth Filter Material _ __..................................... . Distance to nearest: Well -------------- .. Foundation _ Property Line SEEPAGE PIT [ ] Depth .__ . - ...... Diameter _._--. . . ..- Number . _ - ------- _. _ Rock Filled Yes ❑ No 0 Water Table Depth . - ---- ----------------------Rock Size ------------____--_-__-------- Distance to nearest: Well -----------------_----------------------Foundation ____--__________ . Prop. Line --__-__.__-_.__-___ . REPAIR/ADDITION IPrev. Sanitation Permit# _------------- . _..___________________ - Date -----------___--------------------) Septic Tank (Specify Requirements) ------------------- ------- p -Q Dis oral Field (Specify Requirements) --____(..�_A�t-- - t_�l.Y_-.--� rr "1-----�---�'f--------4--•------- --- --. - - -----•--••---------------------•-- ----•------•- -..-------- --------- ...... ------------• -•-------------- ------•-------------------. - - - ----- -- ---- --------- - ------- ------------- --------------------------•------------------------- -------------------------------------------- - ....... - - - (Draw existing and required addition on reverse side) 1 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 Son 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 as to become subject to Workman's Compensation laws of California." Signed - --nn.________----- ------ - Owner By �----- --..- r �Yi7-- - ---- - - ------- - ----------• Title Cr (If er than owner) a FOR DEPAR T,USf ONL yna APPLICATION ACCEPTED BY-_____.--- -------------- _.___. DATE _____y____ BUILDING PERMIT ISSUED -----•-----------------------•--------------•---•--------- --------------------------------------------DATE ••----- ---_-_--•--•---•--------------•--------•---------•-••-•-------••--------------••-----------•--------••--=-•--•---•-------•------_ ADDITIONAL COMMENTS ---- - ------•-- -----••••-•--------••-•-----------------•------•--------•--•-----•- --•••-•-----••-----------••--••------------ -•-•--•----- .................................................... --- ---- --------------•--------•••----------------•-------------- -••------•----- ,. - --- ------•--------------- z .. -.. Final Inspection by: ----•---•------•-•--•-----------•----••-------___--•- Date SAN JOAQUIIv L CA HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M