SU0009927 SSNL - Laserfiche WebLink

Home Browse Search

Aho FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT y ................ ... Permit No. . ... (Complete in Triplicate) ��^ a .............. ...... ............................................ .................................................. This Permit Expires 1 Year From Dab Issued Date Issued !.• Application is hereby made to the San Joaquin local Health District for a permit to construct and install the work heroin N - dercribed. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATIO p70. l rvv_.� ..... ..��. ... .......... �......... ......... --.CENSUS TRACT Owner's Name .................. ........ Phone .� ...... _-.d•-_... Clty . .... ......................................Address ..................... r` G Contractors Name .-.Ti��Lr�-aszl.- .... - z� .--.K? license all .a 3Ff -.: Phoft .... . Installation will serve: Residence[ Apartment House Commercial QTrailar Court 0 Motel ❑Other............................................ 4: Number of living units:------- Number of bedrooms ....?:�.Gorbage Grinder ............ Lot Size .-................................ Water Supply: Public System and name ....... ............................. .....Private,(`; z' Character of soil to a depth of 3 feet: Sand Q Silt❑ Clay ❑ Peat F] Sandy Loam Clay Loam Q 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-,ke" il' NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer Is available within 200 feet) .,., PACKAGE TREATMENT ( ] SEPTIC TANK i ) quid Depth - ...... T Material.--....... .... o. Compartments,,,,..-.,....' « Capacity .. .- . -...-. Type ............. ...... _ .._. �«^-��.,' Distance to nearest: Well Foundation .............. Prop Line '+ Y �' LEACHING LINE [ ) No. of Lines . ._. . ............. Length of each line . --.-_.- ......._ :._.. TWol length «-: '0' Box .-.- . Type Filter Material ... ......Depth Filter Material ..:_.: .. ' ;r a Distance to nearest: Well ........................ Foundation ........................ .''roperty Line`-^"'- '�. 6. > SEEPAGE PIT ( ) Death .................... Diameter ............ - Number ............................ Stock Filled Yes ❑ NO Q�V1 Water Table Depth Rock Cize ..................... P Distance to nearest: Well ................................. Foundation -...................,Prop. Line _.. REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date .................................. ) Septic Tank (Specify Requirements) �I s . �� ...... ..�................a....a..........e..r.}..'t...�.-.¢......`.�...-.........s..C.2......f.....r...._......................- ---- Disposal Field (S ify Rmeats) ..................� eire ................................................... ......... ...................................... �k ......................... ...................................... ..... _........ (brow existing and required addition on reverse side) �N+ I hereby certify that I have prepared this application and shat the work wiii be dune in accordance with San Joaquln -' County Ordinances, State laws, and Rules and Regulations of the San Joaquin Local Health District.Home owner•er lttel� sed agents signature certifies the following: - - "I certify that in the performance of the work for which this perml,, is issued, I shall not employ any person In such manner as to become subject to Workman's Compensaficn laws of California." s Signed --.-.... Owner B ...... Title .." ....................... s (If other than owner) FOR DEPARTMENT USE ONLY ........................... . DATE .�J.-./.-....7 y...__...... APPLICATION ACCEPTED BY..:... 'x�Y.-...-..`...-...... .... BUILDINGPERMIT ISSUED................................................................._..............................._......-DA'iE....................... ..._............. ADDITIONALCOMMENTS.................................................................._..................................._. .-.....-......................_...._........._. ..... ........................................................ .........- ..................... ........... - . . ........................• ...--Date .. -..... .. !/1,I?ir-��........................................................... r7 - Fis,al Ins ection b .................... . .... ._. ..--...-_........... SAN JOAC,}UIN LOCAL HEALTH DISTRICT r� E.H.13 26 i.•68 Rev. SM 7/72 3 M �