SU0006974 - Laserfiche WebLink

Home Browse Search

1PPLICATION FOR SANITATION PE IT (Complete in Triplicate) Permit No. ._....-__ ----------•---------- ........................... This Permit Expires 1 Year From Dote Issued Date Issued 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/LOC�AIJLQNCENSUS TRACT ...... ......... Owner's Name _ Phone .� Address G- City ...... .. ...... . +................ .__....�� Contractor's Name .-T1c � .................................License # ...................._... Phone ....... ...... ............... Installation will serve: Residence ❑ Apartment House f3 Commercial ❑Trailer Court C] Motel E]Other . �7! .-C.':l _-.a.. Number of living units:.-........ Number of bedrooms _._._...Garbage Grinder ............ Lot Size .. ?:- ° .,�-....... Water Supply: Public System and name _________________________________•----__•- _ . .......Private M� `I..D Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam, Hardpan ❑ Adobe ❑ 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,) PACKAGE TREATMENT j ] SEPTIC TANK �" y` b Size.. ..... ........... .............. Liquid. Depth ._�7.. ........... Capacity -�. - '_� Type _..� Material_ iLl, ... No. Compartments _ ....fir.............. Distance to nearest: Well _Q............................Foundation ....40.'-._._.... Prop. Line ..... .:.�.f.. F�r LEACHING LINENo. of Lines r .._�.-_ Length of each line. ........ Total Length .... 10 'D' Box ------.-__-- Type Filter Material PIA,4 Depth .Filter Material ......�d...Pl Distance to nearest: Well .. �'P-._..... ° ° Foundation ......1 '.....--... Property L1ne .-._.. ...._. r f SEEPAGE PIT Depth __S............... Diameter a:_i'�-.��_ _ Number ................. ..-.. Rock Filled Yesq No 0 r .a Water Table Depth .......�-tt1---'--=Y--....................Rock Size .... Distance to nearest: Well -1.:.., ...............................Foundation --------/-L9-.` Prop. Line ......... � . REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ..................................I SepticTank (Specify Requirements) --........................................................................................................................................... Disposal Field (Specify Requirements) _________________________________ ------------------------------------------------------------------------ ------------------------------------------------- ----------------------------------------------...-....-------.......... - ----------- --------------------------------------------------------- ----------------------•---------•----------.......-.-..---..._.........--. (Draw existing and required addition on reverse side) 1 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 Workman's Comp 'nsation�1�f alifornia." Signed -- I f LAZ--------&,t" Owner BY ... - _L^-, i' 7-^ z Title --- .c ---- -- (If other th owner) FORD RTM T USE 0141 APPLICATION ACCEPTED BY - -_ .. - L ---- -. _-.-. DATE .. - BUILDING PERMIT ISSUED -------- --- - ----- -------_--- -- --- -----DATE . ........................................ ADDI TIO AL COMMENTS _________________________________••__- ---------------------•----•------------ ---- ........................... ......................................................... - ------ ------------ -------.. ._.- .................. _-.N-. - _ -------- _ Final Inspection by: ....... ..... --.___Date -. _.. EH 13 2!� 1-68 1 V. 5m SAN JOAQUIN LOCAL HEALTH DISTRICT B/A 3M