SU0005060 SSNL - Laserfiche WebLink

Home Browse Search

JSE AP.,.:,ATION FOR SANITATION PERMIT SV Permit No. --- ____. (Complete in Triplicate) This Permit Expires 1 Year From Date Issued 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 4Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION `--""`!+ `" -------------------------CENSUS TRACT -------------------------- Owner's Name _.._ - M------- Phone ,✓-� '3( `� ---------------- ------ --- -- -------------- Address -- --------- -----5_37-s ---------•------------------ ecity ---- F04 __6_-..Lieense # SW------ PhoneT '--- Contractor's Name - _ -r° Installation will serve_ 18idence [XA artment Houseo Commercial Trailer Court I—) Motel ❑Other ----- -- ----------------------------------- Number of living units:--._l.._... Number of bedrooms --;_I----Garbage Grinder ------------ Lot Size --- ----------------------- Water Supply: Public System and name -------------------- ----------------------------------- ----------------------- --------------------------Private Character of soil to a depth of 3 feet: Sand b Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ 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.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) LA PACKAGE TREATMENT [ ] SEPTIC TANK f J Size------------------------------------------------ Liquid Depth -------------------------- N Capacity - - -- - -------- Type ------------- ------ Material---------------------- No. Compartments ---------------------- Distance to nearest. Well ------------------------------------Foundation ._.------------------ Prop. Line ---------------------- LEACHING LINE [ J No. of Lines ------------------------ Length of each line--------------------- ----- Total Length -----------_---------------- 'D' Box ...... Type Filter MatL-rial --------------------Depth Filter .Material -------------------------------------------- Distance -------------- ------_--.--_. ---- Distance to nearest: Well _ _________ Foundation ......-........--------- Property Line __.--------_---_.._____ SEEPAGE PIT [ J Depth _..-- ----------- Diameter _______________ Number -._.-------.---------------- Rock Filled Yes ❑ No i❑ Water Table Depth ------------------------------------------w----Rock Size -------------------------------- Distance to nearest: Well ----------------------------------------Foundation --------------------- Prop. Line -------------._.--._-- REPAIR/ADDITION(Prey_ Sanitation Permit# --------------------------------- ------ Date ------------------------ ) SepticTank (Specify Requirements) -------- ------------------ ------------------------------------------------------ ----------------------------- ------ --------- --- -- -- Disposal Field (Specify Requireme ts) __-__� -- - � -------------- - --- --d --- -------------------- (Draw existing and required addition on reverse side) I hereby certify that 1 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." iigned ............. .... --------- — Owner ------------------- --- p 3Y ----- Title -... �' b t �` (!f oth an owner) FOR DEPARTMENT USE ONLY APPLICATION ACCE TED BY . ._. _:- --------------------------------------------------------- DATE .� _-- -------_-----_--- BUILDING PERMIT ISSUED ., ----. ..-- - -_---- -. - .......DATE --------------- ADDITIONAL COMMENTS --- ----- ------ --- - --- - ---------- ------ -------------- ----------- ........... ------------ ---------- ----- - ----- -------------------- ------ �_d ----------------------------..-_.... . -- --- -------------- -----.-...--- ----- ----- ------- - --------- --- - ------- -- -- ---- - - -- ---------- ----------- - C L Final Inspection by: .... -- -- "`' -- --- - --Date . . ....__-7--._-/ ..7 SANI InAnI Illi i nrAl WFAI TN MSTPH-T