SR0080702 SSCRPT - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE- APPLICATION FOR SANITATION PERMIT _................ ........ ...•-••-----•-......._ Permit No. (Complete in Tri licate) P P ..............................---.............. 7:j'3-7S ................................................ This Permit Expires I Year F:am Date Issued . Date Issued .........._.....--- Application is hereby made to the San Joaquin Local HealthTlii€�jct--far n perrnit"-o coli sir t'amd"'intall"the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations, JOB ADDRESS/LOCATIOP! �:�G�I.... .....---QvA .............. ...........CENSU TRA' ` ......... .......... �?Owners Name -......_. ...........- _... . . ..Phone .e�---. - r t .... Ci ....... Ck� Contractor's Blame _.:.: '.G-_----- E�.! 'C�`!. •------------------------------License Phone Installation will serve:. Residence V Apartment House Commercial❑Trader Court ❑ Motel C]C]Other-------..-1 Number of living units:_=--------.- Number of bedrooms ._ell---Garbage Grinder;1_ ....--. lot;Sizer X_fp�.___._.....- � , Water Supply: Public System and name .....Cr.1 .__.__.G�/f �e-° ---• c-. _;--------!----' -• :--••••=--------•--Pr[vate ❑ ------ — V Character of soil to a depth of 3 feet: Sand❑ SiltEl Clay ❑ Peau[ Sandy Loam [I' Clay Loam Hardpan I] Adobe Q Fill Material ......... If yes/type ............... ............ i y , (Plot plan, showing size of lot, location of system in relation to wells,'bbildl�gs,%etr. 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 [ ] SEPTIC TANK T ] ...-.-<„.4/js?J__ Liquid Depth --------........,-------- Capacity 1.2 ...._... Type �Materl404?4 A;&ZcZ No. Compartments '.2.............. P Distance to nearest: Well ----•....... ....................,._�ounclption ---<;�-----------.••-•• Prop. line ....... .._._...... LEACHING LINE [ No. of Lines ....-._-.___L.__...... Lengt1� of,each ��li``ne......._Y.4 Frf= -- Total Lengths------�i.�� ...... 'D' Box ..... --- Type Filter Materibl .. ,c.[s.....kk epth Filter M� rial _ _ {/ ....�........................... Distance to nearest: Well .... �......._�� ov�daY{ion _ ..................... Property Line ............ ,-•-•-•• } � ,��/ ff SEEPAGE PIT [ ) Depth ..... .. ... Diameter _ ._._�mbe .......i..... .-�...... Rock Alled Yes ;I No Q Water Table Depth .............................----•----.......I ock Size ...l.X...l�,�_._... .... + i Distance to nearest: Well .......:........�_....._.._.-__-....... oundation .-_--__--_----.-Prop. Line ---------_........... REPAIR/ADDITION(Prev. Sanitation Permit# ................-.....I........---•-:---~-Date --...•-_---_-•---•-_-•-•------} SepticTank (Specify Requirements) .................................1_...................-................................................................................. Disposal Field (Specify Requirements) ............................... t ................................•---•-... ..............._....... - ---------------•-•-•------------------ ........--------------------------...............(----------•----•------.._................................................. .......... ........... I •-- •-------- � -----_....--•.................................................... ................ ..=---_- i t Draw existing and reqFred addition on reverse side) .. I 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 thli permit Is Issued, 1 shall not employ any person In such manner to become subject to Workman's Compensation laws ofiCalifamlo." Signe ................. ---------- -- --------- -- ------ ----- ------- I_........... Owner • f •- w By -- ..................... Title . ....._.._._.._......----.--- --------- . ----- ----.................. (If other owner) FO DEPARTMENT E ONLY _ APPLICATION ACCEPTED BY - . G-dseDrJt��ri/:DATE �. -.?. 7.3 ............... �< BUILDING PERMIT ISSUED .":..... --------------- ......._......._...,.. -----------. _-DATE ---------- ............... ADDITIONALCOMMENTS ......... --- -------------- ---------- -----------•--............----.............. .-----•------ ----- .. ........................................... ---- .......................................... Y ....---...------ ......... ••-----_.............................. ..................................... ............------.. . i' ----------------------------------•--•............ �I) -.... _._._.. .f r��- :_.................. Final Inspection by.. __--------- -- ---•--• ' P :... ::..-.Date .. ....-i.Y�:�s�.__............... Eli 13 2h 1-68 &v. cjM SAN JOAQUIN LOCAL`-HEAL. ;,DISTRICT 8/7h 3M