SU0001178 - Laserfiche WebLink

Home Browse Search

. FOR AOFFICE USE: ' �a PLICATION FOR SANITATION PEF -------- --------------------------------------- 72_' (Complete in Triplicate) Permit No. ---------- ---- _ 1 ------------------------------------------ ----- `� This Permit Expires ] Year From Date Issued IpT�q_--72- GO 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: ., n .- JOB ADDRESS/LOCAT ON �- --!-S ti_.S.,_�±t 74', _FF-------RIX,_ TRACT ---- - _ - -./.. -.- Owner's Name ---- --�.w,r�L-L.------: ---��L-��_�..�y -------------------------- ---------- --------Phone - ` Aj 17 Address ; city Contractor's Name --------, 450i----,[ }d-(_Kt10E-__._, _ VJCEI_icense # ------------------------ Phone ------- ------------ a Installation will serve: Residence �artment House,❑ Commercial :❑Trailer Court !❑ Motel ❑ Other - -------------------------------------- e i �- Number of living units:_-._,----- Number of bedrooms ....Garbage Grinde Lot Size ....... Water Supply: Public System and name ---------------------------------------------------------------------------------------------------------------Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat Sandy Loam ❑ Clay Loom a--- Hardpan " Ado e ❑ Fill Material _ o.__ If yes, type --------.__-_--__.__---- (Plot plan, showing size of lot, locations of system in elation to wells, buildings, etc. m st be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit ermitted if public sewer is availabl within 200 feet,) PACKAGE TREATMENT •T'] SEPTIC TANK"[ ] Size----------------------------------------------- Liquid 'Depth -------------------------- Capacity --------------------- Type ---- --------------- Material-- ----------------- No Compartments ...................... Distance to nearest: Well ----- ------------------------------Foundation ---------- ---------- Prop. Line ----------••----•-•-•- LEACHING LINE [ ] No. of Lines ----- ------------------ ngth of each line--------------------------- otal Length ------- ------ D' Box ------------ Type Filter M tarsal ____________________Depth Filter Mat tial _____._______.___---------------------_._.-. Distance to nearest: Well ______ _________________ Foundation ------------------------ Property Line. ____________-._-._-_.__. SEEPAGE PIT [ ] Depth ----_----____------- Diamet -------------- Number; -.--.--.--._-_---.__-__ Rock Filled Yes ❑ No C Water,Table Depth .- ------------------ Rock Size _-.___.__.. ----- r, Distance to nearest: Well -------- -----------'.....................Foundation ------_--- Prop. Line --------•----------•-- i REPAIR/ADDITION(Prev. Sanitation Permit;# _ IT I'_9l&--r----- - 4V Septic Tank [Specify Requirements) ...... �?J- I-Q. L-- -------------------- _ _ :_ L _ _ _!v- '._________.......... Disposal Field (Specify Requirements)!!._JFXA_S-_r10'V - -----—----- ------------------------------------ .-----------• --•--- ---/206---------66.4--66.4= -A�= - = �� ._;: --- p --------------- ._ ::.---._-`_1_C�/ y---/,C/---tf �,_ -----•-------- (Draw existing and required addition on reverse side) i; I hereby certify theilt I' 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 si atuie certifies the'following: "I certify th in the rman f t e work for which this , y p permit is issued, I-shall not employ any person in such manner as to beco a subiect or s mpensatlon Paws of California." Sig d -- -i-- --------- - ----- ------------- Owner ----------------- ---- f---"®----- .. Title --------- ------- ----- (If other than owner( FOR .DEPARTMENT USE ONLY,. APPLICATION ACCEPTED BY ......t(-13-O--------------------- -------------- ---------- -- --------------------------- ---------------------- - = DATE ------ BUILDING PERMIT TISSUED -----= - :.----- -------DATE ------------- ------- ----------------•---- --------------------------------------------------------------------- ADDITIONAL COMIMENTS".-- ----- _,.. ------- --------------- •-` ---- _... Final Ins -- bY-, :. I'--.- - -- ---• -- - - --------------------------- ----------- --- ----------- - - - ---------- - � . :_..---------------------------Date --- ---� -- �-�___. SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M �,