SR0081403 SSNL - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. ------- -_2 -------- . (Complete in Triplicate) . Date issued This Permit Expires ] Year From Date issued and l the work rein Application is hereby made`to adean comptiancein cwith county Ordinance al Health District for a No. 549 and exisrmit to ting Rules tand Regulations- described. This application .-----CENSUS TRACT --- ------ ------- JOB ADDRESS/LOCATION one Owner's Name l -- -----•-•.City . - -------•--- ------••--- �+ --------------- t -----.License # -.�- Addres t� Y Phone . I Contractor's Name ------------ ``i ! Installation will serve: Residence Apartment House'❑ Commercial:❑Trailer Court ;C] Motel ❑Other :......... ---------- ---------------- Number of living units: .....- _. Number of bedrooms -.-Garbage Grinder ------ ---... Lot Size ......_.. Private Water Supply: Public System and name ---------------- ....................... Silt Cloy Peat❑ Sandy Loam X Clay loam ❑ Character of soil to a depth of 3 feet: Sand ❑ ❑ Y ❑ Fill Material .. .---- If yes,type Hardpan❑ Adobe ❑ _ ----- p t Plot Ian showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.►''�1 ( p I NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) i : 1 X� 11 ----- Liquid Depth --- I PACKAGE TREATMENT [ ] SEPTIC TANK:W ar aSizeS. Capacity./6sp4_�'.. Type 1� ...... Material.-______ - - No. Compartments / V - Pro Line Distance to nea st: Well _....----.�J - ...............Foundation ---- �--- p Total Length �l �( LEACHING LINE [r] No. of Lines ---• Length of each fine .._ - l 3- Depth Filter Material _.-- --/1------- � 'D' Box .._ _�--_-- Type Filter Material _- ._..__.�- --! Property Line •..�--------------- _ ---Foundation . Distance to nearest: Weil--^�---= SEEPAGE PIT [ 1 Depth �- Diameter . ------- -- Numbers-- - Rock Filled Yes C]_. No Water Table Depth --------- -------- Rock Size :..•- -- a, ----Foundation ------- --- -- --- Prop. Line .. _ - ------ ... Distance to nearest:.Weii , .____. • , w= ' �-- .......... Date ---- -------------) REPAIR/ADDITION f Prev. Sanitation Permit Septic Tank (Specify Requirements) Disposal Field (Specify -Requirements ------•---- -------- ------ ------ --------- ------- ------- --- _ �-- - - . --•--------- - --- ----- - ---- ---•- -------- .----- ,----- ------ k --- ---- -- -g -- - l (Draw existin- and required addition on reverse side) hat the work will be ne in accordance t 1 hereby certify that l have prepared this a di Regulations'on and tof the San Joaquin Local oHealth District. Ho etowner or I ienh Son n County Ordinances, State Laws, and Ru i sed agents signature certifies the following: erson in such manner "I certify that in the performance of the work for which this permit is issued, I shall not employ any P as to become sub'yect to War .s Compensation laws of California." Signed --- ---- -C� C G c ..-. Title ...tom - F (If other th ner) FOR .DEPARTMENT USE ONLY _ — - , DATE --- -----•-........................ APPLICATION ACCEPTED BY ._... __ .' --.- ••---•• --------------• ....... ........ BUILDING PERMIT ISSUED .__- -:•._... . .................. .......... _.. DATE ADDITIONAL COMMENTS ----------................................................................ - --- . -- •- .. --- -- - •-- ..................................... ....... Date - Final Inspection by: SAN JOAQUIN LOCAL HEALTH DISTRICT f E. H. 9 1-'68 Rev. 5M