SU0013223 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: FOR OFFICE USE: ItAPPLICATION FOR SANITATION PERMIT 't . ............... z. (Complete In Triplicate) Permit N ........................... ............................. v/1..�� ..... ..._.......................... ..... ....... This Permit 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 Nb. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATIO — � ........CENSUS TRACT........... .......... y.3.. ...... ... . Owner's Name . . . a «�'� - . Phone -• . .... ...................... Address .........,,��.. rf. . . G.ea h. ..�. _........................ ...............City } L T-w�.._.......zip...`. ....:. �..�..r.. Contractor's Name..... ..1........../�/<4.vF.. /�,..... dfQ�...C O...license #E...�� .7.Y..Phone.... 6 ".. //... Installation will serve; Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other............................. ................ Number of living units;.- J .......Number.of bedrooms .........Garbage Grinder. ...........Lot Size............ Water Supply: Public System and name................ ... ...... .......................................Private Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay[X Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe p 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,) PACKAGE TREATMENT [ I SEPTIC TANK ( ) Size.............. ... .......................................Liquid Depth........... . .. . Capacity • - . ......TYPe.......................Material. NCompartments......... ............ .. . . ....� Distance to nearest: Well .................................... . Foundation............. . .. ....Prop. Line.......... ........ ...... LEACHING LINE No. of Lines ...... .... . ........... Length of each line . ................ ....Total Length .................... I •D' Box..:........ Type Filter Material........ Depth Filter Material. ... . . ... ........................ . ..................... Distance to nearest: Well.............. . _. ... Foundation............. ... ..........Property Line............ ................... ..� SEEPAGE PIT ( ) Depth................Diameter.....................Number................................ Rock Filled Yes ❑ No[� Water Table Depth................ ... .. ........................... ....Rock Size _ ..... .... ..... .......................... ..Foundation...... .. . ... ....Pro . . . Distance to nearest: Well. ....... .........................-.. p. Line.............. ... .. ... REPAIR/ADDITION (Prev, Sanitation Permit# ......................................... ... Date............. .... .. ........... Septic Tank (Specify Requirements)...... .. ...... ......... .. . . . .... ... ... . . .......... Disposal Field (Specify Requirements)... . i ?s�1G�/..).. `... .......+f�°j10/(� ..........................................I. . ............. ... ............................................ ....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 San Joaquin Coun Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local Health District. Home owner or licensed ag t signature certifies the following: "I certify that in the performance of the work for which this permit is Issued, I shall not employ any person In such manner as to become subject to Workman's Compensation laws of California." Signed .A........... ......... . -7 . _ . Owner By..x-T!.....� ✓F.Q.�:.•. .. ...,X ..1� W— .............................Title._._....... _ .................... ................ . ............ (If other than ow FOR WPARTMENT USE ONLY 10 APPLICATION ACCEPTED BY.... .. r' ................ . . DATE ......... . DIVISIONOF LAND NUMBER ................... .................................................................................... DATE.... .. ........ . ... . ADDITIONALCOMMENTS ............. ... ... ............................................................. . .................. ............................................................. . . ................................................... .............................................................. ................... .. .. .....................................................................................................................................................................•-........................................ . ................................................. ...................................,. ..............---...... .. ..................... . ............. -. ...................................... .... Final Inspection by: .... .. .. .....................................Date.............................................. ... EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT res ti°» MY. 7176 3M.