SR0082191 SSNL - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: :............... ..... . .. . . ... APPLICATION ' .� . MR SANITATION PERMIT _ ......... (Completo In Tr€ II Penn ••--••�... ..... ........ ....... .. p cafe) _ - it No. ....7:5-----�P-•��S :.... Thls Permlt Expires 1 Year From Dab Issued Date €slued ...............:. . Application is hereby made to the San Joaquin Local Health District for a described. This applicotion is mad® in cam lance with County Ordinance No. it t and Struexistt a Ruin and Re f Permit to construct and install the work herein JOB ADDRESS/LOCATION .._ ..I. :( 9u. ons: fi�� Owner"s N .......C ....... ...... Address .. ................................ a►se�� - 9._�9.-.tea ..............:..... Contractor Q-r • N V o s Name - Y ... . ---...-- Instal#ation ...-""..~ .......License ort will serve: �........................ Phone Residence Apartment Housed Commercial oTraller court � Motel Number of living ❑Other.......... .:...:.. units:__.. ....._ Number of bedrooms Water Water Su / ._....._Garbage Grinder ............ Supply- Public S Lot Size ................... system and name .. .._....-•--•• r Characterdepth .-._...._._ of soil to a .............----- _ . * . .Privarte x of 3 feet: .....----•.............. • Sand� Silt❑ Clay [� Peat � .. Hardpan Q Sandy loam C1 Clay Loam gam" p 0 Adobe*j Fill Material............if yes, a typ (Plot plan, showing size � lot, lavation of system in relation to wails, NEW INSTALLATION: buildings, etc, must be placed on reverse side.) (No septic tank or seepage pit permitted if public sewer is available whin 200 feet,l PACKAGE TREATMENT ( ] SEPTIC TANK it 3 size--- . ------------=-.---- Liquid De • pth :.._ Capavi�' xYpe ..................... v . aterial , ;: --------- No. CompartmeDistance to nearest. ` ------------------- LEACHING --------••-------- fLACHING LIME No:-of Lines . . ...-----•-•---...._.._......Foundation ._....-----••••--__... Prop. ne............. ............•••- __. Length of each line.. .. _ .. Total Len h ..... I f Type Filter Material .................... :.. � Sox ........_... T _.Depth Filter Moteriat Distance to nearest: Well ......... �. cPAGE PIT --'-'••................. foundation - { Property Line ---- [ 1 Depth ...... --•--•• Diameter .......... Number K .... .--.t Water Table_ De � r ............... Rock led Y pth -•-------•------- R Fit es Q No �.�., - •� Rock Siie':............�....... Distanee to nearest: Well ! ..Prop Lin ,y REPAIR D --'....---••••• Foundation t� TION(Frau. Sanitation Permit#.- ••-••••---••-- Septic Tank (S Date --....... .-,Septic (Specify Requirements) ---ta�C.s:•�-, ---- •- ...._Disposal Field ((Specify ments) " - ..... ...--- r (draw existing and required addi non reverse side) I hereby certify that ! have prepared this a and and that the work wl" be done In accordance with San Joaquin f County agents g turces, State Laws, and Rules and Regulations of the San Joaquin Local Health;District. Homs owner or licen' s'�agents signature certifies the following: "I certify that In the performance of the work far which this #o permit is issued # shah not ern as to become su m ect to Wo 's Compensation I sof Ca its employ any person in such manner Signed ... .......... .c.. ._ I---• _ � ' I By = y.. (If other than owner) Sitio _... . _ —�-=-- _ FOR DI:PARTM T�VSE�, NLY 3 APPLICATION ACCEPTED BY_ BUILDING PERMIT ISSUED ............. ---- - -- . .._..---•-•----.....---•---.....DATE _...._... .,. . ADDITIONAL COMMENTS ..............r.._.......__.._._..-.---------•----......._......._....__.._...--•-----._....._............................... . .. ---..._ _...._. _:_..:: ............................ DATE ---- ............. ._._....I...----........_-_.... ---••............... ...... ........................... •----- F. nspection by. ....... - •- EV 13 g 1-68 Nc3v. -----...._.....--- --.... • _Date .......--- - • - ..'�--�- -- SAN t )�AIQN -LOCAL HEALTH DISTRICT '~ B/7h 3M