SU0004496 SSNL - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: "APPLICATION FOR SANITATION PERXIIT _ c - --------------- - Permit No. ._.7.3�y�0 --------------------------------- (Complete in Triplicate) - - - - ?.3-- ------------ ------- - -------- --------- -� Date Issued .__ --":,� -------------------------- This Permit Expires 1 Year From Date Issued 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/LOCATIO _ as -------- 7CENSUS T R ACT _�`----1 -----------•--- Owner's Name ------- Phone Address . J Ie _ ------- - CitY --------- - ` Contractor's Name -� �e- .z �- ------- ------.License #'4,6'!-I/77--- Pho e Installation - ---� '-�"---'-�----- will serve: Residence [Apartment House❑ Commercial ❑Trailer Court :❑ Motel ❑Other ------------------ -------------- ---------- Number of living units:._______ Number of bedrooms .__.3-----Garbage Grinder - _ Lot Size -------�7 -----__.---. Water Supply: Public System and name fCr7 ____----------------_------------------------------------------Private J Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe X 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 [ I SEPTIC TANK 0� Size-/-O-,' �X sir-_ ------ Liquid Depth --_-_ --------------- 0 qua 6�F.�. No. Compartments - ='� --- CapacitY� ---- - Type � _- Material--- - i In Distance to nearest: Well ____® _----------------------Foundation _._ �__- -__._-_ Prop. line ----`� ............ INi LEACHING LINE IV No. of Lines ----------Z--------- Length of each line......Z ---------- Total Length -- -------- 'D' Box ----/---- Type Filter Material � __-.--Depth Filter Material __l_y__________________________________ Distance to nearest: Well ___- ----------- Foundation -------- Property Line ...�--------------- 1 q ` SEEPAGE PIT [ Depth _.�S _-i Diameter Number ----. --____-...___/Rock Filled Yes P' No ❑ Water Table Depth ---------- d-----------------------------Rock-Size --------1_Z-------------------- Distance ----------------Distance to nearest: Well ____ ----------------•_Foundation __- ------ Prop. Line .--- _-.---_- REPAIR/ADDITION(Prev. Sanitation Permit# _-----•.---------------------------------- Date ----------__--.---_-.-____-------) SepticTank (Specify Requirements) -------- -------------------------------------------- ----------------------------------------------------------------------------------- e DisposalField (Specify Requirements) ------------- ---------------------------------------- ------------------------------------------------------------------------------ - ------------------------------------------------------ - - - ------------------------------- ------------------------------------------------ ----------------------------- ------------ (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 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 �C��"rte-fir_.._ l!?� Jl --- Title ---- By = - - - (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _�- � - ---------------------- -------------- ------------- DATE ----------- BUILDINGPERMIT ISSUED ----------------- --------------------------- --- -------------------------- ----------------DATE ----------- ----------•------------------- ADDITIONALCOMMENTS ------------------------------------------------------ --------------------------------------- ----------------------------------------------------------- ------------ --------------- ---------------------------------------------------------------------- ---------- ---------------- ------- --------- --------- ---- -- -- - -- ----- ----- - ----- -- --------------------------------------------------- fj� ---------------------- ---------------- - -- ---- ' -------------- ---------------------------------- ----- ------- --------DatFinal Inspection by: -- ------------------------------------------------------ SAN - - SAN JOAQUIN,LOCAL HEALTH DISTRICT `'