SU0005079 SSNL - Laserfiche WebLink

Home Browse Search

L FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT --------- --------------- - (Complete in Triplicate) Permit No.7r:!.....:5_.._a _..._._.._._............. This Permit Expires 1 Year From Date Issued Date Issued...�:� ..:7� 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.-------------------------- v - - - -- - Owner's Name---------` '-'- -.�..412h: --- ---------- ---------------------------------------------------,p � Phone-------------------------------- Address-- --- - 7 -------------------------- »' -C' - d6—z-41-1-------------------------Zip--- ---------------------- Contractor's Name----------t:;: --------------- - L ea-- q � /F -� License O-344' ro- - - - - Phone ❑ ----- Installation will serve: Residence Apartment House Commercial Trailer Court Motel ❑ Other------- ------------------------------------ ` Number of living units:._..____--Number of bedrooms.._"/---Garbage Grinder------------Lot Size._._------"_"__.-------------------------- -------.__.-__..._..._---- LWater Supply: Public System and name -' —' ' ' - -------- ----------------------------------------Private ❑ Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat❑ Sandy Loam❑ Clay Loam PT�_ Hardpan ❑ Adobe❑ Fill Material-------- ---If yes, type---------------------------__. r (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,) r, PACKAGE TREATMENT [ ] SEPTIC TANK [ -----------------------------Liquid Depth_.- _..____ Capacity. oe-�-------Type-_Jy--,�_c"-u--"-o-- -r-�- Material---C"'-"' ----_------No. Compartments---2------------„---_------- / Distance to nearest: Well.___-_.' Q. . ------.--------Foundation------- L.p. ___ Prop. Line._ S/^__-----__... LEACHING LINE [r] No. of Lines.... ._...----------:-----Length of each line.__._,.�-c�____-Total Length------ Zp_ _____---- 'D' Box----I------Type Filter Material._.__.3.9----Depth Filter Material........Pq------------------------------------------------- _ Distanceto nearest: Well-----tdQ---tt__.Foundation-------tL?�._.Property Line_.._ Rock Filled QYesNoSEEPAGE PIT [rDepth---2SkfDiameter..._ -- ___.Number-------. _. _ ------------- /. _____. __ i Water Table Depth----------- 15�ARock Size----/�,N/,:� y- ❑ Distance to nearest: Well----- _SP- -.__._.__..__.._.__Foundation----- ------Prop. Line--- REPAIR/ADDITION (Prev. Sanitation Permit#.__________ -------------_-----....--------Date............. ........................__.___) Septic Tank (Specify Requirements)----- ------------------------- --------------------------------'--'--------.----------------------------------------------'-------- DisposalField (Specify Requirements)'---'------'-----'--- -------------------------------------------------------------------------------=---'--------------- ------'------------- r (Draw existing and required addition on reverse side) 1 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 Rules and Regulations of the San Joaquin Local Health District, Home owner or licensed 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 Compens ion laws of California." Signed-----.,.--------------------------- wlnor ite -L� - -By - ... . - - ' - rl (If other than owner) FOR DEPARTMENT USE ONLY All _ APPLICATION ACCEPTED BY C= - ' O - ------------------------------ DATE.-�- ..Z-2�.._.... - DIVISION OF LAND NUMBER........ -----'--' ---11--.............'------------------------' .... ' ---DATE_----------------- ADDITIONALCOMMENTS----------------------------------------------------------------------------------------------------------___-------------- -------- --------- ------------------------------ - -------------------------- --------------- - ---- Final Inspection by:-------�-'-- -n..-. --- -- -`-----------------------------------------------------------------Date.,ld--/ -- ----------.._. IN 13 24 __ JOAQUIN LOCAL HEALTH DISTRICT Fb5 27677 REV. 7/76 3M