SU0005060 SSNL - Laserfiche WebLink

Home Browse Search

.�_E USE: AP' .ATION FOR SANITATION PERMIT x_ I.W Permit No- ----------- (Complete ----- ----(Complete in Triplicate) ------- ----------------------------------- - 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 lescribed. This application is made in compliance with County Ordinance No_ 549 and existing Rules and Regulations: �� ,y.--- 1�� CENSUS TRACT OB ADDRESS/LOCATlO .�j- - 3wner's Name .... � '� Q - Phone \ddress ..._ -City _ ---------------------- ;ontractor's Name a ,`z � License # 1 _ y Phone nstollation will serve: Residence ❑Apartment House❑ Comme�, ial❑]Trailer Court 0 Motel ❑Other _-------------------------- -"------ 4umber of living units:. 1_ .... Number of bedrooms __� -_-Garbage Grinder ----------_ Lot Size _. x_=L- —"- =------ Nater Supply- Public System and name -------------------------------- _------------- --------------------------------- ---------------------------Private :haracter of soil to a depth of 3 feet: Sand ❑ Silt ElClay ❑ Peat E] Sandy Loam C1 Clay Loam Hardpan ❑ Adobe ❑ 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.) 4EW INSTALLATION: (No septic tank or seepage pit permitted if/public sewer is available within 200 feet,) S 'ACKAGE TREATMENT I I SEPTIC TANK Size-�- _.l --- Liquid Depth --.q..__ _____------ n Capacity -- �-��.0 Type �/t'`--' Material_ 't" .._-_ No. Compartments ------------ $$ Distance to nearest: Well ___.__--_ --------Foundation eterMoterial i ____ Prop. Line ___ �:__. EACHING LINE [t'( No- of Lines ----- Length of each line.-:- _ QTotal Length ---_l6_o 'D' Box -_-f Type Filter Material ----- ----�--Depth Fi _-.------- ----------------- --- Distance to nearest: Well -----J76_ Foundation -__-_C -- Property Line -_ -- -)EEPAGE PIT [ ] Depth -----_------------ Diameter _--- __ Number --------------------.-- -- Rock Filled Yes ❑ No i❑ WaterTable Depth ------------------------------------------------Rock Size -------------------------------- Distance to nearest: Wel! ----.------_---------------------------Foundation -------------------- Prop. Line ---------------------- tEPAIR/ADDITION(Prev- Sanitation Permit=# ---------------------------------- ------ -- Date ----------------------------------) Septic Tank (Specify Requirements) ---------------- ------------------------------------------------- --------------------- DisposalField (Specify Requirements) -------- ---------------------------- ----------------------------------------------- -- ------------------------ ---- ------------- --- - ------------ - - ----- ---------------------- ---------------------- ----------------------------------------- ----- -------- ------------- --- - (Draw existing and required addition on reverse side) hereby certify that i have prepared'this application and that the work will be done in accordance with San Joaquin :ounty Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- ed 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 is to become subject to Workms Compensation laws of California." igned .... ............------------ --- -- - '` ------------- --- ---- ----------- - Owner - -- Y .......... _ -y�k�� - --------------------G -::. -.- title _... f!'_............. ."............. ----------------- (if other than owner) FOR DEPARTMENT USE ONLY aPPLICATlON ACCEPTED Bl�..- ---... ----------t J - 3L1lLDING PERMIT ISSUED - -- ------------------ >DDITIONAL COMMENTS . ------------------ - ------ ---------- -�`� -- ----- - --------------------------- --- ----- t------ -- ------------ -- ----- --------------------------- ---------- ---------------- -- ---------- - ---- --- ------ ----- r ----------- _ S-7 :incl Inspection by- '- `- 2 `�- _ Date .:... .... ....... ............. SA JOAQUlN LOCAL HEALTH DISTRICT �' -