SR0085850_SSNL - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 7S--', � Permit No. .................... ........................... ..._---.......... (Complete In Triplicate) J l Date issued .�'.3:•.�.-•• f This Permit Expires 1 Year From 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: ... o.cl...CENSUS TRACT .......................... JOB ADDRESS/LOCAT ON ....-�'�-�/�- r-�`��• �`' •• ... �. _. f_....._� ---..._.....Phone .. .........�_....�4.. iOwner's Name .........-•.............•.._.....•......... .`'11`'.. 1 , Address ... 4�J% - .. M�.r.4'�X_._1a,��...._I.......... City -----/��?!iL.............. Contractor's Name ......................... .. • ._... ...... _..__.._ ........••--_.__........--•-•-.License # .......... ............. Phone .._........................... Installation will serve: Residence 9Apartment HouseO Commercial )]Trailer Court �] Motel ❑ Other ............................................ Number of living units: _..../.... Number of bedrooms ...- ...Garbage Grinder __.......... Lot Size .__-'f.--G�-...... �� iWater Supply: Public System and name ....................... . ..._............ •-•••--• •_•_.__•-----Private Character of soil to a depth of 3 feet: Sand' Silt ❑ Clay j] "Peat ❑ Sandy Loam j] Clay Loam [] I 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.) l' NEW INSTALLATION: (No septic tank or seepage pit permitted if p blit sewer is available within 200 feet,) // + ] <;�= !. .Liquid Depth _.... .......... PACKAGE TREATMENT (� SEPTIC T NK Siae._.... aU--- / ..... Type �,F>�417—material--- R o, Compartments ----- .•---••-•• Capacity . -. yp r Distance to nearest: Well .......... I/ .............Foundation ....��.�._.--•- Prop. Line .,� d-•-•----- } F LEACHING LINE [ ] No. of Lines .... Total Len ii�l d •-----„�,-_--.__-. Length of1each line..._._..--�--:-• gt M 'D' Box .._. �..- Type Fitter Material �' ..-Depth Fi} r Material _...._ ... -_ 4. I - Distance to nearest: Well _....,/B ........ Foundation ------ ...0 Property Line ........... SEEPAGE PIT Depth Diameter ................ Number ............................ Rock Filled Yes ❑ No ❑ Water Table Depth Rock Size ......................... _ i Distance to nearest: Well.......................... .............. Foundation .......... -....... .. Prop. Line ...................... REPAIR/ADDITION (Prev. Sanitation Permit # ......................... Date ........ .---_•-•-•••-•- •••-•••) ' Septic Tank (Specify Requirements) .....I.....................,....__.•.-................. 1 p fY eq k Disposal Field (Specify Requirements) ............................................................._......._._._._......__.._._____.....__--____....---..._.__...___--. f• -----•.....................-.:_..__.-- ......_..---•-••-----••---•.....-------...---....---...------ ._............................................ (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- j 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.” ____ Owner Sign•• --•- - - ........, ........................ � ---- B_ ... ._.. , . f other than owner) A �� USE ONLY FOR DEPARTMENT U F APPLICATION ACCEPTED BY... _.......:..............•------------.. DATE ... _ BUILDING PERMIT ISSUED ....-.....,c�.�.....1....... �-. ATE . ADDITIONAL COMMENTS .......... �......x. .�•"r ��-Z -. 4..!....---•-._....--•---_.-- f _ .. �/ -----•...........................................................--------------- ...._............... _._....,.__..............._........_.-........._......-... 1 t� t. ................... a .. Final Ins ection b '••---_•.D ..............................•-.........._._..__...... SAN JOAQUIN LOCAL HEALTH DISTRICT �� , 7/723,14