SU0001684 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USF.: ' APPLICATION FOR SANITATION PERMIT Permit No. ..'�._,�� (Completo in Triplicate) Date Issued . ... This Permit Expires i Year From Date Issued 41 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: : : D- .... CENSUS TRACT ...V...7...7.... JOB ADDRESS�1. TIppN I -ffl ` a SJR f`E Phone ............................. � ( M. Owner's Nome r...... ... ... . ........ ....... _ .........City .... . Address .....�vL' GQ. t a ztsw fid fir. Phone ... ............... u Q..license -~ Cont-actor's Name .... � — '� Installation will serve. Residence Apartment House❑ Commercial ❑Traller Court ❑ Motel ❑Other . ...... .. ................................ x Number of living units: .... Number of bedrooms ..y....Garbage Grinder ............ Lot Size ...................•• . ..............Private Water Supply: Public System and name . ............. ......................................_..................................... , Character of soil to a depth of 3 feet: Sand ;/Adobe ilt❑ Clay (:) Peat❑ Sandy Loam C1 Clay Loom❑ a° Hardpan C3Fill Material If yes,type•••••••••••••••••••••••••••' ^ :L (Plot plan, showing size of !ot, location of system in relation to wells, buildings, etc. must be placed on revere side•) ; NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is avoilable within 200 feet,) Nk . Size.................................................. liquid Depth ».............»..»..»: %4 I� PACKA_GE TREATMENT [ 1 SEPTIC TANK j ] Capacity .. .... ......... Type .................... Material............:......... No. Compartments Distance to nearest: Well ....................................Foundation ......................Prop.line...... .»..»»_ ......... Total Length ..............••.....»_. LEACHING LINE [ ] No. of ones ... Length of each line.................. < Depth Filter Material 'D' Box .... . . .. Type Filter Material .................... ..»_.......- t nearest: Well Foundation ........................ Property tine ....... , Distance o SEEPAGE PIT Depth Diameter Number ......................... .. Rock Filled Yes C1I No (>i WaterTable Depth ................................................Rock Size ................................ Foundation ........... ...... Prop. Line .........»»......». Distance to nearest: Well ........ .•-•--••-••�••••• •• .............. REPAIR/ADDITION(Prev. Sanitation Permit$ ............................................ Date ..................................) Septic Tank (Specify Requirenents ..................... ......................................._........................•.. ..... . ................... W ...................... Disposal Field (Specify Requirements) ° ..... . .. . .. ............. ....v..... .. .. ✓. ., ....---.................1. ..ea w. -••................................. . ' _ (Draw existing and required addition on reverse side) � • "�; I hereby certify that I have prepared ibis application and that the work will be dent in accordance with San *AO" County Ordinances, State Laws, and Rules and Regulations of the San Joaquin local Health DisMct.Nome owner K more. sed agents signature certifies the following: p P ort In such tnertster 'A ,,I certify that in the performance of the work for which this permit Is issued, 1 shell net employ any pin as to becom subject to Workman's Compensation laws of California." Signed .... V..... ...... .. _ J Owner ................................. B ............. Title . ('-... y (If other than owner) r' D FOR DEPARTMENT USA ONLY p ' ° APPLhCATION ACCEPTED BY .if... ? �GGt ...................... DATE .f/t�.1'�(P............ ».. BUILDING PERMIT ISSUED .. . ..... ............................................... ...... ...................................DATE. ....»... s=: C ADDITIONAL COMMENTS .. .......................................................... .............................. .... .................................................I........................... ...................................................................................... ....... .... ............................................Date ,l.r�r t�................ /,� ... Final Inspection by: .• �%'' • ......•••... • ""' SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1•'68 Rev. 5M -=i