SU0007802 SSNL - Laserfiche WebLink

Home Browse Search

FCR-OFFICE USE: FOR'OFPICE USE: APPLICATION FOR SANITATION PERMIT � 791 ........................................ .. (Complete in Triplicate) Permit ......... ............... _ ......._.._.._- Date Issued... .............. This Permit Expires 1 Year From Dote 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/LOCATION..... ......C-fv-w (---- ------ JRACT.........._......_.._-------- Owner's Name.....Ll..-----....�bq�.4t...................___...... ..........Phone .._ .wi92 ..........r_...................__............city./WW!!Y?Z7 19.___......Zip... � 3 .... Contractor's Name.....A-4. .................... _.................License #,02J -11ron..Phone.,73../�:lr�`��a_. Installation will serve: Residenceg Apartment House C] Commercal❑ Trailer Court❑' ' Motel M Other........................................ .. . t � / Number of living units:...... --- of bedrooms_3.....Gorbage Grinder... .'......Lot Size...5------ y4........._-.____.... Water Supply: Public System and name..........................-..............._................_....-,, . .........................-------- . .-..................Private Character of soil to o depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam W 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,) C Y" PACKAGE TREATMENT SEPTIC TANK yc9 .Liquid Depth... ( ] [ [ size....cwt.K.9..... --�.5.....................- - Capacity. ..�lH?........Type � Material............ No. Compartments........... _ Distance to nearest: Well......eAP....................... .....F//o��undation._AQ........._.. ....Prop. Line...s....... ...... LEACHING LINE [ ] No. of Lines-. ..'....___....... Length of each line_.../6..................Total Length .....42_!1 Q.......:-_.......-_.. i 'D' Box..*�,..k.Type Filter Material��..l�,pepth Filter Material_...._ll�'... ._........................._.........._. t 1Distance to nearest: WeII..I.1•.r.�..�.............Foundation------ .a.FT......Property line......]D....�...............,� SEEPAGE PIT [ ] Depth.._:._:,......Diameter....................Number...............................- Rock Filled Yes ❑ No❑l ` Water Table Depth.................---------- ...... .....................Rock Size. -------...---— ............. Distance to nearest: Well_....... .. ......................... ...Foundation.--- ---------------------Prop. Line............ ............. REPAIR/ADDITION (Prev. Sanitation Pe`emit#a,-07�-....._..---------------------------------Date_ ..----------- __....... ......... ...... ) Septic Tank (Specify Requirements).... is .. ........_............................._.........._...... -- - -------- ........... ........... - ------............. Disposal Field (Specify Requirements)::r............. ...".. .................... ......---------------------------- _........_......... I Y ........... .......... ............... _.1 ....... -............................................... ........... ........._.... ..........__ ...................... (Draw existing and recuired addition on reverse side) I hereby certify that 1 have prepared this appliccition and that The work will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Requisitions of the S�Jaaquin Local Health District, Home owner or licensed agents signature certifies the following: r', "I certify that in theperformanceof the work for which this permit is issued, 1 shall not employ any person in such manner as to ed me,subject ject t '� s Compensation laws of California." Si neceme,sub[ect.1... Workmar` ........--'-e`-.........................-Owner By------_! ......... ................ ....... --.13 --- - . .......Title (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- v Xll� - .... ... _.. -- .....DATE - _.._. DIVISION OF LAND NUMBER..........:......... ...............-.......... ._...--------.._----. .............. ........DATE......__ ............-......._........... ... ADDITIONALCOMMENTS.............:.. .---- --- :C......` ...........-_...._.. -.-...............- -._......__.......... ...._..........__..__ ................. . - / 1. _ ...................1 ------------------`----------------..- ............ .>'---=-.:......-..........-- _.::i--'-- .. .. ......... ........ - .... ..... - ...... -l%r... --- . ...... .... .. -- .Inspection by:.... -ET - " 13 24 SAN JOAQUIN LOCALHAH DISTRICT TO 21677ee 3M