SU0003930 SSNL - Laserfiche WebLink

Home Browse Search

PPLICATION FOR SANITATION PEr 'T L i.• Permit No. (Complete in.Triplicate) ^ ........................... This Permlt 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 Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCA ON .._.. ...[...5.. .T...._ •---..��......_ ......................CENSUS TRACT .......................... Owner's NaCme ..... _ /.- .......... ................••••-••--............ ..................Phone ......................... Address ........z ----••----- :; � ...............City . Contractor's Name _.- ' T G _ _ /(�'!�j( .. license # .o�� _. Phone -----------------------_----- Installation will serve: Residence Pq Apartment House Commercial❑Trailer Court ❑ Motel ❑Other............................................ Number of living units:.... Number of bedrooms ....q....Garbage Grinder Lot Size 1� -- .... ._...__ ------- -• .... .... ................. Water Supply: Public System and name .......................................................... ------------------------------------------Private Character of soil to a depth of 3 feet: Sand W Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan[] Adobe 0 Fill Material ............ If yes,type............... ............ (Plot plan, showing size of lot, location of system in relation to wel(s,'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 [ ] SEPTIC TANK ] Size. l..L. �.', z� .............. Liquid Uquid Depth .. .................... ...,.. Capacity ZkQ0 Type ,(l .f t! M` jjaterial.�'?!t- ^ ... .No. Compartments Distance to nearest: Well ...../0_Q. Foundation ../01........ Prop. Line _____ .............. ---_ Length of each line..._.2d LEACHING LINE No. of Lines ..... [ J `J�...__...._ _ Total Length ............. 'D' Box .... ..__. Type Filter Material .1i......... ..Depth Filter Material /�` ..�_� ........... Distance to nearest: Well ..../Q.�?.._ Foundation .....%0. .......... Property Line 5.............. SEEPAGE PIT [ j Depth ...................... Diameter ................ .Number ............................ Rock Filled Yes ❑ No ❑ Water Table Depth ...___.__._••-•.................................Rock Size ................................ Distance to nearest: Well ........................................Foundation .................... Prop. line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date .................................. SepticTank (Specify Requirements) -•-----•--•-........--••-•......................................••-•-•---.........._.._..._..--•-•-..........--•-------------•------..__.... Dispbsa) Field (Specify Requirements) ----•-----•-•----...----•--•--•..........................................•--• ............-- --------------------------------- ........._..a i..................................................................... ..... (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work will be done In accordance with Son Joaquin County;Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health-District. Home owner or Rin- sed agents signature certifies the following: "I certify thatlss-sloe performanc of worms hich this permit Is issued, I shall not employ any person in such manner as to be esu t to Wor C s 1� gf California." Signed . ---- ----- - -- . Owner .. By ................................. -------•-------------------••--------•••--...---•-----•.............. Title ..---.................. (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ...... . .. .. ...... ..••.... ... -•--.....,. .: :.. ................. DATE ......5..-.3 BUILDING PERMIT ISSUED ....... ................. ------- .. - DATE . ......................................... ....... ADDITIONAL COMMENTS .._... :_.... _.... ................................................................................................................................................•. --• ---...-•...................•-.........................................._........•-•............................................... ....... ......................... ... Final Inspection by: ........... ............. ..................................................................................... . -- ... ..... .R.._....Date ... .. ..� •- .. . .. ... ........................................ .... . .. .. �' 1:.. EH 13 2!, 1-68 )Lev. .. SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h X4 161. ' r -