SR0082717_SSNL - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT . Permit No. ...--.._ :_....(�.l..a.�.__ �r- �J/ iCompletein Triplicate) ,. ._ __. .. _..,..... This Permit Expires 1 Year From flag Iswed Date Issued . ,f .d..... 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 unty Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION .... ./.. ...._._.. �,... j....-�`` .............CENSUS MCT ----------------.-•----- Owner's Name ....-- ._... ...._. .... ,................:...:..:.......... ..Phone - -� Address .................... .... .... :_._ _ .. ...City. . ._.c� ... '`'�...._.......... .-. _.......... r.... Contractor's Name - ........:............License'# �71.�.�1.__ Phone ��.-.--- - Installation will serve: t Residence M A iirtment House 0 Commercial:QTrailer Court 0 Motel Q Other................:.........I.......I .......� ; Number of living units:_.-._ --.- Number of bedrooms ` .----Garbage Grinder L -. Lot Size . l ...�.... -------•--••-•- Water Supply: Public System and name ._..:.:_`-_......_----•- ....................._._....._....._......_-------............. Character of soil to a depth of 3 feet: Sand T2 Slit 13 Gay ❑ Peat Q Sandy Loam 0 Clay Loam r] 4 Hardpan Q AdobFill Materia} '___... .._If yes,type (Plot plan, showing size of lot, location of system in rotation to wells;buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if publicsevrer is available within 200 feet,) PACKAGE TREATMENT°;( } SEPTIC TANK{.J . , Size-------------------------•-..................__. liquid Depth ..........................�y Capacity -------__---•--... Type .................... Material.............::...:_. No. Compartments , '� I Distance to nearest: Well .............................. Foundation ----_--------- Prop. Line .....................� LEACHING LINE 't ] No. of Lines .............:.......... length of each- line...............-.......------ Total length ....._... ................. 'D' Box ........... Type Filter Material '---:.. Depth Filter Material Distance to nearest: Well ____________________J.. Foundation ........................ Property Llne ....... SEEPAGE PIT � ) Depth i............. ........ .. --_.-r.� . . . Diameter Number .......:.................... Rock Filled Yes ❑ No 4 1%. Water Table Depth ................................................Rock Size .............................. Distance to nearest: Well ........................................Foundation ............:.----.. Prop. line .................... REPAIR/ADDITION Prev. Sanitation Permit# - • Date ....:...... . ) Septic Tank (Specify Requirements) ...:................ ......../C. ........... __.. ....-_..._............. .._ Disposal Field (Specify Requirements) ._..,�!� _.1.. ~_.................. ................................................. I /' .................. •---•.......I...........I............... ._... ----------- --------- .... .................................................... -----....--- ------------......_...........--•••....._._.............._..........-••--•-._..................----.._._..... ...................... (Draw existing and required addition on reverse side) I hereby certify that 1 have prepared this application and-that the work will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin local Health,District. Han* owner or ficsn- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit Is Issued, I shelf not employ any person in such.Wanner as to become subject to Workman's Compensatio aws-of-California." _ r Signed . _-------- ..................... :' Owner ; ByY . :.... .. . / ............... Title ..................... .. . ........ ... ilf oth an owner) • S t` FOR PARTMENT E .ONLY *. APPLICATION ACCEPTED BY _... ......., DATE BUILDING PERMIT ISSUED .... 1� r . . � --- ......................AQDiTIONAt COMMENTS ... ' - _... A -- .......... . . ............................. . .... ---....... .........., . . ......- .. .... ............ .......................... ....... . Final Inspection b ...Date ..:.I....`.. `.'-•-- .... P y fi1� •--•................ ...................................................... . EH 13 24 1-68 Ilea. 5m SAN JOAO N LOCAL HEALTH DISTRICT 874 3M