SR0085850_SSNL - Laserfiche WebLink

Home Browse Search

,• FOROFFICE USE: APPLICATION FOR SANITATION PERMIT �.....................•---........---....... i Permit No...% {Complete In Triplicate)- ......{.................................................. ' -... 7/6 ................................... This Permit Expires 1'from Date froDate 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 ADDRESSAOCATiON G. ��...... �. Ck i..).nc/V..-j tr h -..CENSUS TRACT ...0_14� .............. Owner's Name ...... sr.-?.' . .............N....... ........................Phone Address ._... City1.�..?- .................... .... .... .r..- _ .. ............................ Contractor's Name ......... se # .,: 7.i :....... Phone ............ Installation will serve: Residence ❑ Apartment Hou j] Commercial ❑Traile� Court 0 Motel Bother _.►n�dlt~-. i'7 t ,, / e Number of living units:. ........... Number'.of bedrooms _ 3._.._Garba�e Grinder .......__.._ at Slz ..fat..,��'-.�-•••.••---.0 Water Supply: Public System and name t0--.........................�......... Private er . Character of soil to a depth of 3 feet: Sand tK Silt ❑r Clay ❑ Peaf ❑ Saridjl Loa ❑ Clay Loam s �i Hardpan p Adobe 0 Fill Material ..........1t .y�s, ty e ..............�..:... (Plot plan, showing size of lot, location of system in'relationtto Weill, buildings, etc. mus be/plocod an reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sever is avoila� within 200 feet,) PACKAGE TREATMENT [ J SEPTIC TANK ) Size..t �a a �_:"'b . ... :_............ Liquid Depth - ........................ Capacity %Ut?._ -- Type" Mater G� ----No. Compartments ...2........:�- . ................ Foundaf2ar�..�� b ... Prop. Line ....s .. , .... Dis ance to AC_. 1 LfAC NG LINE Not of Lines near, W�I) of each tine...,. -k i Length ...------•--•-• 'D' Box ... I....... Type Filter Materia %'. ...•Dep#h Fiji W -•Mate at":...... :%1 .......:............ -_•. Distance to nearest: Well .... Foundation �_._. f ¢V........ Property�,Line .......... { j Depth Diome-------- Number ................ ock�illed� No 0 Water�� = ...._..: o ize ......:............:....:.. a De ..,.... •� Distance to nearest: Well . \,% ,:.Foundoti r. .:..-.......... Piop. Ina.. ......::::::.... . REPAIR/ADDITION (Prev. Sanitation Permit # .... ............... -• .. .............. Date ......... .__.................. _..} Septic Tank (Specify Requirements) . # Disposal field (Specify Requirementx).._ ._..x ..��.X14.�,.............�.... ----- .............................................................•---- ........ ........................... ................ ........_...---.......-• ....................... . -• I {Draw existing and required addition on rever � side) I hereby certify that I have prepared this application and that the work will b dons InIatcordante whh' San loaquln County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health!: District. Hof»e owner or (icer• sed agents signature certifies the following: urr i, "I certify that in the performance of the work for which this permit is Issued, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed--................................................ ............. Owner By... ..................... ................... .._...--........... ------ Title ...... ............. ... _ _ (if other than owner) DEP6RTMENT USE ONLY APPLICATION ACCEPTED BY......��y00o�dAi.............••._....._......._.__.- ..-...:.,.. DATE 71,76 .............. BUILDING PERMIT ISSUED.. tti � r �r._....! S:r:.,..... _. ......DATE ........... ................................ ADDITIONAL COMMENTS .......••••.............•••.••• --------------------------------- -.. ---------------------_-- .............._.......------------------_----- .............. ........................... ......................•---- ..... ...---............ _ ...................... Fina._.Inspection by.. ........................• • __r. fj'' . -- ---------•-....-----•..---•-.----•......---------. Date ..:G. /T7 EH 13 2L 1-68 Rev. SM SAN JOAQUIN LOCAL HEALTH DISTRICT 8/71, 3M