SU0006561 - Laserfiche WebLink

Home Browse Search

�J 'I APPLICATION FOR SANITATION PERMIT ... .... . ....... 7 5- (Complete in Triplicate) Permit !�lo. ..._.... --------- _.-._...- This Permit Expires 1 Year From Date Issued Date Issued ..- z ...�J Application is hereby made to the San 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 ' �.. f / %�//j q/V' CENSUS TRACT ... . Owner's Name _N ......... . ...............:.._.... _.. ..... .....Phone Address -Z $4 4 o.A,-' - `-% _. .. .. ........... City -Sjuc nTc.�/L' . . . ........... _..._.. Contractor's Name . ... . ....._..License # .�.��/..... Phone .".. . . .. Installation will serve: Reside e Q Apartment House0 Commercial ❑Trailer Court 0 Motel ❑Other . .......... ............................... Number of livingunits:.. .._...... Number of bedrooms __ (0Z,�'.,1%� Garbage Grinder .. .. ...... Lot Size ....... . .. ................... Water Supply: Public System and name .......... --- .. „..,---- __............... Private ID Character of soil to a depth of 3 feet: Sand❑ Silt Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe 0- Fill Material ............ If yes,type ............... .......... . (Plot plan, showing size of lot, location of system in relation to wells, 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,J PACKAGE TREATMENT [ ] SEPTIC TANK 4' 1, Size.... ..X ./ --,N?r.. ..... Liquid Depth ....�.1�~ ............. Capacity . ype . MaterialNo. Com artments �. `J Distance to nearest: Well - ire :.................Foundation..... ........ Prop. Line . .. ............. r LEACHING LINE [ J No. of Lines . . _. ._-.._._. Len th of each line.. . 9 -.S.C°...... - .... Total Length ... ��............... _J D' Box ....�-. Type Filter Material ..�.; . . //..Depth Filter Material ....� �............................. Distance to nearest: Well .. ... Foundation .....__. Property line _5............... 3 SEEPAGE PIT [ J Depth ........ Diameter _7`. . Number . _.._. ............... Rock Filled Yes [ No Water Table Depth `� / --------------------------------Rock Size ._ _. ._ e.c.=/'�'...... � !l A Distance to nearest: Well ...�% .��::...................Foundation _.. ..�.... � ...... Prop. line .. .............• 3 REPAIR/ADDITION(Prev. Sanitation Permit# ............................................/ Date ..................................) Septic Tank (Specify Requirements) ..... -��} Z?P_'�e -,�ziA.e........ 4-7 ..................... Disposal Field (Specify Requirements) -------------------------------------------------------- -_--_-- ---.................... ----------- ---- ................... ---. . ----.. .---... ----------.........------.................................................... --------- -------- .. . ----------------------------------- .....-.................................................. ....................... (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. Home owner or licen- sed agents signature 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 to Workman's Compensation laws of California." Signed ....... ------ ------ ------- ------------------------- Owner (If other n owner) R DMARTIM'PVT USE ONLY APPLICATION ACCEPTED BY _ __-� DATE . ,� .-2 - ............. ---- .. -- BUILDING PERMIT ISSUED ...__.. .. .. .. .. . ....------ -- --------------------- _.-........DATE . .. . ADDITIONAL COMMENTS _... . ._ ------- ----- -_.. .. . ------------........ .. ... ----.... ................... ... ................._. .. ---- ----.. .. ....................... ..... ................ ........_ ..........._...... _ .. ------------- Final Inspection by: /�f .G� Date EH 13 21� 1-613 II V. 5M SAN JOAQQJN LOCAL HEALTH DISTRICT 8/7/7h' 3M