SU0004825 SSNL - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT y (Complete in Triplicate} Permit No. _ _7....-..-.--. _ - ...-- -- --. 3-3- 7-5 This Permit Expires i Year From Date 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: i 1 F' JOB ADDRESS/LOCATION lC. --- {. � �- ..-... . ....... . .....CENSUS TRACT -------........ , Owner's Name _ -- --- -- -----------...-Phone _4 tt..39�/V _`......... ..fL.. � ; ff642�- C�tY...C... .ff. ...4 .. ... ....Address - ------------------------License c'2Contractor's Name � Li. / A. Installation will serve: Residence$6 ApartmenjHouse-❑ Commercial ❑Trailer Court ❑ I i Motel p Other -------------- r ,, Number of living units:....'/__.... Number of bedrooms _Garbage Grinder Lot Siz .� )�jam-- -_.-------.------ f Water Supply: Public System and name ................... -----..... -------------------- Private t Characterof soil to a depth of 3 feet: Sand Silt . Clay Peat Sand Loam Clay Loam. � P �❑ ❑ Y ❑ ❑ Y ❑ Y i❑ Hardpan ❑ Adobe Fill Material,"....- If.yes, type r (Plod plar, showing size of lot, location of system in relation to wells, bui[dia-gs,f etc. must be placed on;reverse side.) NEW INSTALLATION: (No septic tang;or seepage pit permitted if public sewers available within 200 feet,): 4._ Do ! PACKAGE'TREATMENT [ ] SEPTIC TANK I ] Size-------.-----------------_.. . .. ..... .. ..... Liquid Depth ..ti.--------------.---.... { f Capacity .-- .. Type Material-_-- .14._ No. Compartments ; ----------------- A?isfaric6 t.o_nearest: Well .. --------- - - ----Foundati n .. .. ..-...-- Prop. Line, --------------------• LEAdHING LINE [ j No. of Lines ength of each line _ . ........ ... Total Length ....f._....-------......... h D' Type Filter 14 terial -------------- -----Depth Fil er, Material .... ....... ----,....... I t �- 4 N Dist' nce,to n arest!-Well ...... ................. Foundation '" _...- Property Line a.-.----__-- --•---_--:- SEE t4GE hT } � Depth _... Diamete ------. Number .. ... . ... .. . ....... Rock Filled Yes ❑ No C3 (. Water Table-Depth -- -------- -- ----------------------------- -Rock Size . ....--- --- . Pro Distance to nearest: Well ---- -- --------------------------------Founda - - --.. ....-- p= Line;---------- .-..._..-- REP IR/ADDITI N(frev. Sanitation Permit# -- ---- -.. ------------- Date -.---- -----L., # 5e tic nk 1epY _eq}ufir:ements) 1 = ......----- � -Di posy Fie . Requirements) , � ------ ---- ,.._ .... - :...... ... _. ' � ► --- ----- ------ (Draw existing and required addition on reverse side) I he eby certify that I h6ye.prepared this application and that the work will be da a in accordance. with Sari, Joaquin Courty OrI�1 inpinde's,", tate tAs, and Rules and Regulations of the San Joaquinlocal kealth District. Home owner or licen- sed agents.signature ertife�s tlte,�followiny: .' r "I certify that in the.perfo mance of the work for which this permit is issued, I shalC� of employ any person ir} such manner as tc become subject°� rkm IS Ca ensation laws of California." Sign d ' -- --------------------- Owner ,Y B Title . ..... _. ' (if other than owner) FOR DEPARTMENT USE ONLY f y APl'll A I( N ACCEPTED: BY . . ` Q... . .. ..... ....- . ..._ . . .. DATE ... ' 177.75------ -- BUILbING 1' lt 'P ERMIT ISSUFED- ..DATE b -.------. LCOADD)TIONMENTS - --- L ---- ...... .................. --.--------.-------------- --------..-. -- 7FinansD fe- . . ......... ..