SU0005021 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: PPLICATION FOR SANITATION PER T Permit No. .. - - ------- .. ....... - ../ �{.6 (Complete in Triplicate) This Permit Expires 1 Year From Date Issued Date Issued ...-. ..�.�-Y ___ --------- --------------_-_------ 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 compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION .... ..-.CENSUS TRACT --- --_../----- ll Owner's Name _W-E.a - �0-1_ t�1T.-- ---_- 7 k°' I-.-..__G4 V.Q---- ---- ...Phone q- ----------I------[,dj, Address ----------- ------------ ------ --. City ---------------- - --------------------- Contractor's ---------- -------- Contractor's Name ----- 0-W ----------- - ------------ ----------.License # - Phone ----- .............. Installation will serve: Residence ❑ Apartment nnHou//s��e�❑//�Commercial QTrailer Court :❑ Motel ❑ Other-C..YAJ"_-+a.-6'taZ----- i Number of living units:11.6W Number of bedrooms /.YteftQGarbage Grinder/XW_ Lot Size Water Supply: Public System and name -_-dr-° . .2.d --s _-AtA—`Q1-.ALY iV--------------------Private Character of soil to a depth of 3 feet: Sand ❑___ Silt Clay ❑ Peat❑ Sandy Loam Q Clay Loam ❑ Hardpan ❑ Adobe El 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.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK Size-_100©_- __._.--.._ Liquid Depth -----.---._------------- Capacity . - Type ---------------- Material---- - ------ No. Compartments Distance to nearest: Well _ -------------------------_------Foundation ------_4------------ Prop. Line ---._.--___-_--_-- 1 LEACHING LINE X No. of Lines ....1.---------- ___ Length of each line.X)A,_Mt#;V - .- al Length _._----- _.. 'D' Box .hFPQ__ Type Filter Materialfc fta_&O' Filter Material .1.7...-----------------------............. Distance to nearest: Well -.._-�c--__._._ Foundation ---- Property Line ..-----:- SEEPAGE PIT [ ] Depth __... ............ Diameter --.__.--__ -- Number ________-.._..._:_: Rock Filled Yes C] No Q Water Table Depth ........Rock Size _.__._---------------------- Distance To nearest: Well _.-___ -----------------------------Foundation -------------_---- Prop. Line .............._.----.. --96160N(Prev. Sanitation Permit# ------------------------------------------- Date -----------------------------) Septic Tank (Specify Requirements) ---------- -------------- ----------------------------- - ------------------ Disposal Field (Specify- Requirements) _-. - _ _ ,K1 .a(;--- ----�(h�-----V o----,-- -- �Q- --- -- -- - -------------- (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 County Ordinances,,State Laws, and Ruies 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 become subject to Workman's Compensation laws of California." Signed ----- --- -- --- - - -.------------- Owner By .----- Title f.�. .�-�fl��1 ...... - (If other than owner) --------- -- --. . FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _ ._-- .. .~ -------- -- - - - --.. ....V. ---- ---.-- ..-----. DATE .3_-1-3--21-..-.---.- BUILDING PERMIT ISSUED .--- - --- ------------ - --- -- I---- ---- .DATE ---- ----------- ------- ADD ONAL COMMENT - - ---- - -- -- - ------------ .--------- -- . -- --- --- -- '�1�J tK::::cer44 c � -moo- e c ��e L`^ -------- ---- - .. ----- .. - -- - - --------------------------- - -- -- --- - - - Final Inspection by. .---- ae - -- - ... Date SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M