SR0084479_SSNL - Laserfiche WebLink

Home Browse Search

FOR 6FFICE USE: ------------ .................. ................ ...... ............... ......... ------------ ---- APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) This Permit Expire;'i Year- From Date Issued FOR OFFICE USE: Permit Date Issued. 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/LOCATION �---�,/&,,-02,�...---..V 4--- - / -� . --CENSUS TRACT....... ........ _SWr A .......... . .... ; . Owner's Name...... ......... .......... ......--_-•- ...... ......... Phone .... ... .. ....... Address....._ ............. 5.,4.,ve ... . ....... ........ ...... .............. *_."�'. city ... ........ ............. * ...... Zip_': ............ L, L_ at Phone. 46-_;:F_8 ---------- Con'ractor's Name ..... ...... . ......... ........ ...... I ....... Installation will serve: Residence E] Apartment House 7, CoIrmerciol C] Trailer Court 0 Motel ❑ Other -.Il -A-c- Number of living units:. ................. NumSer of bedrooms..____. Garb6ge'Giinder ....... _..Lot Size ....... ...... Water Supply: Public System and norn6 .... .......... ...................... ...................... ....... ...... .."-Private Character of, soil to a depth of 3 feet: Sand ❑ Silt [] Clay ED Peat E] Sandy Loom [I Clay Loom ❑ HardponE] lEj Adobeo Fill Material If yes, type_..._....................... (Plot plan, showing size of lot, location of system in relation to welts, buildings, etc_ must be placed on reverse side.). NEW INSTALLATION. (No Septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT SEPTIC TANK I Size 6 5.r4- - X 57_- .......••-•••"•••••-•--• Liquid Depth.. . \� .1 ...... 1::Z -•-.•------ P ......... Cacicity_/�;P6�1 ....... T ype.,Ae-oF 4:41 Vr- M a ter i a I ............. ....... :No. Compartments `rr- — Well al -.,A- " .... Foundation.../ / .. ----- -- 01 Distance to nearest. ... ............ _ ....... ,�7"C'7 ..-Prop, Line.- ..... . LEACHING LINE No. of Lines ................ ...Length of each line .,j --- Total Length .. ............ 'D, Box../. _.!Type Filter Material. Filter AKater'10'I,..—.,. ...... ................. ...... 17, Distance,to nearest.. Well. -la -1-0 ..............Foundation...,. .5 ...... .... ...... Property Line.. -I:>_. -P. ........ Rock Filled Yes [-I No SEEPAGE Pit Depth *.Diometer!�__'� .............. Number QI I , 11 4., WaterTable Depth.._.._-- ........... .......................... ........ Rock ........ . ........... '- ........ Distance to nearest. Well.. ........ ......... Foundation ........... I . ......... ...Rrop. line.._.........__..:_.... . REPAIR/ADDITION (Prev. Sanitation Pe; mit ...::............_............._._-...Date ............. Septic Tank (Specify Requirements) -L-.......- ...................... ............................... ....... Disposal Field (Specify Requirements). ...... ... . ............ ............. ---11 ...... .--.-t ........... .... .. ........... ............ ... . .................................... ................... .......... .............-.w ........... .................................. J, �_l _4 .................. ............. ...... 1-11.1--- ...... ................................. ......... ........... ......... .......... ...... ......... (Dro 'existin -and required addition on reverse side) I hereby certify that I have prepared this application and that the work will be done in accordance with sarii Joaquin County Ordinances,f, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licensed agents signs re 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 I 7k m an Compensation laws of California." Signed.---... ... .. ......•........ ......... Owner. By...............T,._.,......-.._ Title..._........_._._................... ........ (If other than owner) I APPLICATION ACCEPTED DIVISION -OF LAND ADDITIONAL COMMENTS ......... ......... POR DEPAJRTMENT USE ONLY DATE .................... DATE--: ... I ...... - - - . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . .......... ........... ....... ....... ............. ....... • ........................... Final Inspection by: EN 13 24 I _/ ....... .............. - I ...... ................. ........ SAN JOAQUIN LOCAL HEALTH DISTRICT .......... I ........ ........... ....................... ------- ...... . _ ........... 1- ....... .............. .Date_ cc� &S 21677 REV. 7/76 3M