SU0013255 - Laserfiche WebLink

Home Browse Search

r FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ... .. ............ ... (Complete In Triplicate) Permit No. . ?. ..".3 g... ... This Permit Expires 1 Year From Date Issued Date Issued .-S................ Application is hereby made to the Son 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: i JOB ADDRESS/LOCA�N �1. �1" �Z . . .... CENSUS TRACT ....... .................. I Owne:'s Name ....4 . � yn�%�k... . t: ..... .Phony Address . . ._.� �. ...�� Z: C')�jy ,tet_ `...... .City ...� :�.............. .... Contractor's Nome .... t:74t �..:r _ -/{ f��/K... ...... t............................................. �.4.�.. . .... .?-. license ,i� .lc?j Phone ................ Instollo'ion will serve: Residence E Apartment House 0 Commercial oTrailer Court 0N••N- Motel ❑Other ............................................ N-1mber of living units:.. . . ... Number of bedrooms ....,>....Garbage Grinder lot Size ........................... Water Supply: Public System end name . .... ................................................_..................................................Private Character of soil to a depth of 3 feet: Sund❑ Silt❑, Clay ❑ Peat❑ Sandy Loam ❑ Cloy loam • Hardpan ❑ Adobe ❑ FiII Material ............If yes,type.............. t (Plot plan, showing size of lot, location of system in relation to well., buildings, etc, must be placed on reverse side.) NEW INSTALLATION: (No septic runk or see ge pit permitted it ublic sewer is available within 200 feet,) ' PACKAGE TREATMENT [ ) SEPTIC TANK j Siz@.� .. eZ�.ZS�.......... Liquid Depth 7 ................. 14 e Capacity /, cr• �� Type `'• . Material..�I?�G..,•.. No. Compartments ...., . .. .. r.� , V Distance to ne est: Well .........,.�......................Foundation .Zee.............. Prop. Line...1............._. ' LEACHING LINE (�No. of Lines . ........... length of each line..........51K........... Total length .............. 'D' Box Type Filter Material ....... s. ....Depth Filter Notarial ......./...F........................._..... Distance to nearest: Well ....... ....... Foundation ...../r.' Proporty Lino .........��o .` SEEPAGE PIT ( Depth .a �. Diameter �' N ..... Number ..........�.............. Rock Filled Yes : Water Table Depth .............. S../.....................Rock Size f ...�1.�......�.j....... �. Distance to nearest: Well ..........,�5^ ..�................Foundation ..../... ..�..... Prop. Line .......... .......». REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date .......................... Septic Tank (Specify Requirements) Disposal Field (Specify Requirements) ..... ................................................................................ 'i M1�l .. . .. ......... .................................... .. .. ... ...................................................................................................................................... i ........ .......... .. ........................ ... ................I......................-...............................................................I............................ (Draw existing and required addition on reverse side) 1 hersby certify that I have prepared this application and that the work will bo done in aceordanu with San Joaquin County Ordinances, State laws; and Rules and Regulations of the Son 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 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 ... ....................................... ......................................... .ilc .. i 2..... Owner By . . .. Title ...................................................... (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY..! /.::..�.:.:.�..�...l.,r.�sf..................... .................. DATE ..Z.7..'.�'.:..�.V.................. BUILDING PERMIT ISSUED ....................................... .DATE ADDITIONALCOMMENTS ................... ................................................................................................................................... . .................................................................................................................................................................... ................ Fina..Inspection...:..........~ ..►.r.f '/....................................................................................•................................................. Y / ..... ......................................................................Data .J'.' ..� .................... SAN JOAQUIN LOCAL HEALTH DISTRICT W� E. H.1-3 24 1.'68 Rev. 5M 7/72 3,K