SU0009927 SSNL - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: n n Al PLICATION FOR SANITATION PERMIT ? Permit No. ..73 /US�,� ... _ (Complete in Triplicate) -. Date Issued i This Mermtt Expires 1 Year From Date Issued Y y _ = Application is Fereby made to the Son Joaquin Local Health District for a permit to construct and install the 'Work:.heroin %.'. described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations. bio -�......... .. ...CENSUS TRA ` x� ,r JOB ADDRESS/LOCATION . -- �r R Owner's Name ... ----_ -- ".� ............Phone......... City Ly AddressZ .�/ ' .License #off �. .-o� Phone Contractors Name...977 �'-�- T } Installation will serve: Residenc partment House❑ Commercial ❑Trailer Court fl } ' Motel ❑Other. ... ......... ................. --------- a Ac R Number of living units:....14.... Number of bedrooms ._-I.. Garbage Grinder .-..Lt.. lot Size �� Water Supply: Public System and name ......... - - ... _..._..._....... ......... :... ..... .. Pr vate " r - -- '?+ka5 ^ Character of soil to depth of 3 feet: Sand 0 Silt F1 _ Clay E] Peat F-1SandyLoam � Cioy loam , 7, ,4, Hardpan❑ Adobe ❑ Fill Material ............ If yes,type — -- -- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be plated on reverse . NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet) PACKAGE TREATMENT ( ] SEPTIC TANK j ] Size..... ........ ......... ..... ...... .. ...... Liquid Dep*h a Capacity .��1-b-'� TYpe ��1 G'J1..C.,L rial--- --_ -- No. Compartments ..: �.� Distance to nearest: Well .... ,-4�-------- -••- - -Foundation -. ..................... Prop line 6.6 LEACHING LINE [ ]. No. of Lines .-..�.. .. Length of each !ir,e Total Length D'.Box /......_ Type Filter Material l.`h. R6ckJepth Fi ter Material I.`�..__ y Pro a Line Distance to nearest: Well ........................ Foundation --- p rty, -2; s rDiameter .. Number .... .. ... .... ... Rock Filled Yes ❑ No ❑, a SEEPAGE PIT [ j Depth �S w Water Table Depth _-... ..................Rock Size .. , Distance to nearest: Well Foundation .... Prop. Line 1: ••.... K` Date --- .::__-•-••-••-) c r r REPAIR/ADDITION(Prev, Sanitation Permit# -.--•--••-•--• / U v ........... •.............................•.......... .... Septic Tank (Specify Requirements) ---------------------- ----- Disposal Field (Specify Requirements) 6 --t .. _._ ..................................... A 5 ..... ..... .............:........... �+ .............. -t>. - .... _..... .. .... Y Sys ---..- (Draw existing and required addition on reverse side) certify that t have prepared this application and that the work will be done in accordance S hereby with Son Jeoquln s County Ovdinances, State laws, and Rules and Regulations of the San Joaquin Local Health District. Home OVI/t1K er IItNF r. t r sed agents signature certifies the following: - < ` , "I certify that in the performance of the work for which this permit is issued, ( shall not employ any person in such monnslr as to become subiect to Workman's Compensation laws of California." ., .. -.. .. .., Own.e_. r .._.Signed Title Y .. . ......._... "i!8, r tho caner) Pi FOR DEPARTMENT USE ONLY ` �{ DATE l�2 .�..3............ APPLICATION ACCEPTED BY.- _... .. ............................................. DATE .. .. BUILDING PERMIT ISSUED ..... --------------..................•..........................__..-................................ ... .... NAL COMM.ENTS........................................:........................._..::.;:...._............... ;ADDITIO _......._..... _.. --... ........ r ..... ---- ------------- ......................• ............. ............................ ............................. t . __....... .................................. n Date .. X $ Final Inspection b �"""""" a SAN JOAQUIN LOCAL HEALTH DISTRICT E.H. 9 1-'68 Rev. SM ;t