SR0074690 - Laserfiche WebLink

Metadata

Thumbnails

Annotations

FOR OFFICE USE: CZL 4 � 4 APPLICATION FOR SANITA 1 N PERMIT .__.. .. Permit No. .......... (Complete in Triplicate) This Permit Expires 1 Year From Date Issued Date Issued .3'..3tQ-7' 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: JOB ADDRESS/LO TION . 7., /l�V.r..---. - CENSUS TRACT .... Owner's Name�T"+s'°t Phone..' �.�&.• Address a City _ ... .....__..-..._- ... Contractor's Name _ ..0, ........... ..License #/0.V,Z//... Phone .416k.. i j Installation will serve: Residence ❑ Apartment Houseo Commercial oTroiler Court fl Motel Q Other Number of living units:........... Number of bedrooms ...........Garbage Grinder . _. _.. Lot Size _...." ......... Water Supply: Public System and name .................................... ._•..,..........-._..".._................ ........ .... Private ❑ Character of soil to a depth of 3 feet: Sand D Silt ❑ Clay Q Peat Q r Sandy Loam Q Cloy Loom Q ( Hardpan Q Adobe_ fill Material .........._I .f yes, 4I __-...-...... _.. i(Plot ,plan, showing size of lot, location •of, system in relation to wells, buildings, etc. must be placed on reverse side.) U t .• • ., NEW INSTALLATIONi'1 -N, o I;e,p c tank or seepoge.pit„perini�ed if public sewei s avpilable within 200 feet,) PACKAGE TREATMENT (] SEPTIC TANK Size.S'.��C..L 7. -. Liquid Depth /+ Capacityi Wr .�T... Type Material. G111VC r _ No. Compartments . L-........ r I Distance to nearest: Well ..Foundation Prop. Line._ -.. LEACHING LINE No. of Lines . ........... ''Length ,of eac')i ITne - r✓�� . �' Tota( Length ....r�� r •cJr r�� 'D' Box _.. ✓ Type Filter' Materlbl� 'ICV-1pp ---j .....Depth Filter Material ._. Je..'. -.- .......-- -- Distance to nearest: Well...........ci}.FoundationlProperty Line S ...... t c►:..� .� tom: -- l`>✓ : .� Diameter`` SEEPAGE PIT Z�Cj` 1 Depth ...Z� -.. 3.. .._ . Number. >..... r.,. ock Filled Yes`�j No fl f - t _S17 / s��' r/ Water able Depth'..:............__.._._._.....Roctke��s...'�''L _. Distance to neorest: Well ._..t'... ___..;.....Foundation 1�- Prop. Line I” * *........ \� REPAIR/ADDITION (Prev. Sanitation Permit # __ ... .... -_.. �_� �.. Da e� 1"- `.t:�. ---""-.•� Septic Tank (Specify Requirements) -- Disposal Field (Specify Requirements) ....... .... . ..._........................................ _ .. _....._....... ........._......-. __.. i— _ . (Draw existing and required addition o;:reverse side) I hereby certify that 1 have prepared this application and ihat 1the• w1ik,Lvlll be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San,Joaquin Local Health district. Home owner or licen- sed agents signature certifies the following: a 1 j "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 _. Owner B r Jitle r .................. .. . .. By _. .. '(' If other in' owne'rl" ARTMENT USE ONLY. APPLICATION ACCEPTED BY .. _. DATE—tea %� I BUILDING PERMIT ISSUED ... ✓� �� r. 1 DATE ADDITIONAL COMMENTS_- _... ` .._ """" ......_- ..... ........... _. - i-�i'7 .... ... . _ ..... ....."."-.- _......................."..".........."................................- .. ........... _...... .............."......I., . _.-..-..-."."".."".._-.._ ........ ....__. ..... _ _... Date ' %Y ............. Final Inspection by: /{ ..........."."".......... a e .....- ..._ .3. _ .. N AQUIN LOCAL HEALTH DISTRICT