SU0003866 SSCRPT - Laserfiche WebLink

Home Browse Search

r ,v k I FOR OFFICE USE: APPLICA TION FOR SANITATION PERMIT fan �r Permit No. ..73"........_.. (complete In Tdplica!a) ........._............................. ._....... ...... P Dote issued .................................._.... ................ This Permit Ex iros 1 Yoor From Date Issued .1. Application is hereby made to the San Joaquin Local Health DistriC foraermit to construct and Install the work herein described. This application is made in compliance with CCou�n�ty�Ordinor,ce No. 549 and existing Rules and Regulat!ors: JOB ADDRESS/L ION .r...L ... ......`rf..... �✓:f�!' :+:_ G.' .......................CENSUS TRACT .......................... ay,lJ / .....Phone ._...................... .......... Owner's Name . . . .e.................................................� . ...... ... .. j �7...... ...................................... Address ..............._...... .�. rn.. - '�''[� /CF Ci C%11;�.'[.................. L... ... .. ........................ ty .... �c..{JZ„ ,•.............License# ... Phone .............................. Contractor's '. "."" '".'.-' Installation will serve: Residence[1f' Apartment House❑ Commercial ❑Trailer Court ❑ Motel ❑Other............................................ Number of living units:----- ..... Number o+ bedrooms ....)/..Garbage Grinder ............ Lot Size 4-0' 5 e rP..:... Private . Water Supply: Public System and name ....._ ................... .................. ......--- ................................................... _ . Character of soil to a depth of 3 feet: Sand❑�t Silt❑ Clay ❑ Peat El Loom [I Clay Loam ❑ Hardpan 141 Adobe C] Fill Material ............If yes,type........................... ,. (Plot plan, showing size of Ict, locution 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,) PACKAGE TREATMENT 17 SEPTIC TANK t i:. Size............................. .......... Liquid Depth .......................... Wl Type Material...................... No. Compartments N i Capacity ................... yp Distance to nearest: Well ....................................Foundation ...................... Prop. Lire ...................... . t .... Total Len iF. --.... LEACHING LINE ( I No. of Lines ........................ Length of each line..-.------ . ...... g """' P I ............................................ Z 'D' Box ............ Type Filter Material ....................De th Fiter Material ° Property Line Distance to nearest: Well ........................ Foundation ........................ p 1 N r SEEPAGE PIT [ ] Depth .... ............... Diameter Number ............................ Rock Filled Yes ❑ No �l Waler Table Depth Rock Size ................................ ............................................... Distance to nearest: Well . ......... ....................Foundation .................... Prop. line ............... ro REPAIR/ADDITION(Prev. Sanitation Permit t$' .......... ................................. Date ..................................) p (16? Septic Tank (Specify RRequirements) ..........5._. ....... � .......................�. .. _J.—.. . ._.........._....._ ' _..._.... r Disposal Field (Specify Regoremen}s) ' .. ........ ...3 ....d..... _.. k (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 Ordinances, State laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or [icon- Countyced agents signature certifies the following: "1 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 lows of California." .. .. ...... ..... l .� 2. ....... Owner Signed...__ . ..._ __... i1i9j6� L� CJS/ .L.t,i.ln'1 By .. ..._...... .. ........ pf other than owner) i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .... ✓i1:=: l J _:c..c.{.�a.�-ft ...... ...._.... ...... ._ ..._... DATE _.�.............7..0... .......... _ BUILDING PERMIT ISSUED. .. _ .........DATE .,_...... . .. ... .... __.. - ..... . ... ____ . . ADDITIONAL COMMENTS - ............. - - .. . _._... __...... .__... .._. ..._.._.._._ _ __.._...__.__.............................._. ......... .. ..... ` .. _ _ ... ..... ... .................................. _ v. .. ...,... ...... .� ._ -_Date !u, Final Inspection by: ,/.i.. �._ _. . ... F...-. ."�'�... . .. ........ L SAN JOAQUIN LOCAL HEALTH DISTRICT b 1Ti CL E.H. 9 1--68 Rev. 5M