SR0082251 SSNL - Laserfiche WebLink

Home Browse Search

• 4 FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ..........................................,.... /� 7 /07 S� lComplete in Tripii[ate) Permit No. ..................... .............................. ......... ------ This Permit Expires 1 Year rom Date Issued Date Issued Application is hereby made to the San Joaquin of Heal h istrict for a per ;t to constructand install the work herein described. This application is made in compliance with County,,,brdia -No. and existing Rules and Regulations: JOB ADDRESS/LOCA .. _..... '.V%1 _ f�JTRACT >. ., ..............CENSUS P._re, :..._.. . .. .� Owner's Nome ....... ..... .......... ............ !tP ......._..... ................................ Phone _e 047 ........_ . Address ......... .�0 ?/ Contractor's Name .. .......... .. .. . ..... _.. '7'i/J,.,-..•----•.License # 3.f/C?.�..__ Phone %0 , ..., In t ilati n will serve. Residence XApartment House❑ Commercial❑Trailer Court D Motel ❑Other ........ - ' Num ber of living units:.....(... . Number of bedrooms ..__...Garbage Grinder ............ Lot Size ............................. Waters pu ply:^blicSystem and"in me ..............•-----. ..................... --....,.......-.-...---.............._._..........................Private Z Character of soil to blepth of 3 feet: Sancl 0 Silt❑ Clay ❑ Peat❑ Sandy Loam Q Clay loam ❑ �� ti Hardpan j Adobe Fill Material ........__ If yes,type................. . tip••r. (Piot plan, showing size of lot, location , f-system Wtjelation toywells, buildings, etc. must be placed on reverserside.) � �.�1 ,��• �... y It �i� NEW INSTALLATION: (No septic�tp1nk•.or seepage pit permitted if pvllic sey e� is available within 200 feet,) .moi PACKAGE TREATMENT [ ] SEPTIC TANK S}i�e4 "` Li uid'De th t�7.... .. q P Capacity .fes Type Material., No. Compartments --- .......4.- ... Distance to nearest: Well-, �10 "1_-_.._....-._..-Foundation ....`!0, 't'..., Prop. Line ..... %�`..... �"` .. Length of each line....... LEACHING LINE No. of L'+nes g �.5.�.._....... Total Length ...170............... 'D' Box .._.-. Type Filter Material .4-r ....Depth filter Material .......... ................ d Distance to nearest: Well ....,V..II ..._.__ Foundation 4P.- Property Line ..�.I 7`.......... t SEEPAGE PIT j Depth .:_ ._... Diameter .T3........ Number .......�- '..........__ Rock Filled Yes v No ❑ f( �. �y �[ Water Table depth _..------------ = a�.s � .Rock Size ..IX-. ._ ii Distance to nearest: Well .......(�'4V____ _________________Foundation ....1/fJ..-f-.---. Prop. Line ..._...... REPAIR/ADDITION(Prev. Sanitation Permit# ...................................--------- Date ..........------------.---_--_---_) SepticTank-{Specify Requirements) ...... ............. --..............---------..........................._.._..._.......-•----.....:..........._........---..._.L.._......._ Disposal Field (Specify Requirements) ----- - --------------- --•--_- ---- ..........._.... ..................... .......... ..................... ... .. (Drdw existing and required addition on reverse side) F hey'by-Irtify that I have prepared this application and that the work will be done in accordance with San Jea uin Count rllinonces, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agent:l-signature certifies the following: "I cerhiAthat in the performance of the work for which this permit is issued, I shall not employ any person in such manner as'to bestoAne subject to Workman's Compensation laws of California." I Signed .... . .:. ........... .. ......_..... ..... .._. -- Owner ........... ... By Title . ... ' ........ . . .... ............................ (if othe t an owner) FOR DEPARTMENT USE ONLY AP,PLICATI N ACCEPTED BY ... .......... .._...... �............ ...._.....----- ----......... .......... DATE ... ..a0 _. ...:_....... BU,ILDINGPERMIT ISSUED ..,. ..... DATE .-.. ADDITION L COMMENTS ..//. o . - J............. ........ .....:. .. _...4_ ........._..f.......... ....•-_.. . .........._......._.................-••--•---_................_..._.....-• ---....................... .......... ---------- ------•------ ...........---......... .........................-......-----.....:._..-•-••-........ ---............_.__......... ......... ..... .... ................. . ,Final Ins a tion b . ------------ -•--r - - 7j�- ........... SAN JOAQUIN LOCAL .HEALTH DISTRICT