SU0002690 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ' - --- - -- APPLICATION FOR SANITATION ?-"MIT- _ Permit No. -Z..z-'-.dr._5..7 (Complete in Triplicate) .................. -------------------------------------- Date ._....-------..-..-.------.--------- Date Issued • _ -------------- ---_. --------------.-------- This Permit Expires 1 Year From Date Issued 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 comrpliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION NEW. 0-N---1_D----�5._.Fl_I_1.VAfy_..�p1--`f-----------------CENSUS TRACT ._--7-----------............ Owner's Name -.f ,x_15.. //� f \1p-_---- ^ L<�-cf�.itt •- Gt C 5:.uAX__. .L�1.40LE---Phone Address - ----- -----2-�--I..... - -1 E1'\.D_QL...A--VE------. City --- ........ .... - ------- 7 ' 2 Contractor's Name .--�R-krr.�-�-5-�'"------- '"......--------------.......-....License # `��1---- PhoneInstallation will will serve: Residence ❑Apartment House fl Commercial []Trailer Court Motel ❑Other .—V Ls,<..._/ct�t��!��l} L (i r�/L Number of living units:---- Number of bedrooms ............Garbage Grinder ---.__ ---- Lot Size 2_ :� -.r .............. Water Supply: Public System and name -------------------------------------------------------...................................................Private Ksy Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe' Fill Material _ If yes, type ---------------------- 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,) i PACKAGE TREATMENT [ ] SEPTIC TANK X . -__---- - - - -. Liquid Depth � - -t - -- -- - ---• Capacity Type E� $erMaterialr.rM4k. : No. Compartments Z------•-•---- Distance to nearest: Well ...fc.y_ .._.1y-------------Foundation � I __,[ti-__�'..__.- Prop. Line .Z-----T...-_- , LEACHING LINE ;Fd� No. of Lines (L-)--------------- Length of each line-._,Sr..../...... ...... Total Length .L7�'....-----------__- 4,1J e r! 'D' Box ---*------ Type Filter Material�_�...!;r - _Depth Filter Material L..A-------------------------------------- 1, Distance to nearest: Well ....... Foundation --------- Property Line _s.._. SEEPAGE PIT [ ] Depth ,....... Diameter .1,311..... Number .1""1 / Rock Filled Yes No Water Table Depth _- '.............. Rock Size .L ,7,i •cjz<.... t / / .--;;�..---------. , s Distance to nearest: Well ___L_4.4..........................Foundation A .... .._ 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 1 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 as to became s bject to Workman's Compensation laws of California." Signed �. ,'�t S ------------ �► l . . . Owner BY A.L. -..-'_:_ _ T..S:-'.� �.-f:.+►r % - - Title -....._j * r;.�.�-ti.' . -.-.._... _. -.. (If other than owner) DEPARTMENT USE ONLY _ APPLICATION ACCEPTED 3Y - DATE _.... . . BUILDING PERMIT ISSUED . ----- ------------------I . DATE _ ... _ ADDITIONAL COMMSry-- _ '. .. .. - --.. . ------------------.. --- - -- -- .. . . . ... ................ --- - -- - - -- Final Inspection by: ..._. - -- --------------------_.----__..----......Dave .. - ,� .. . . ..... N JOAOUIN LOCAL HEALTH DISTRICT E. -'68 Re . 5M