SU0009625 SSNL - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ----------------------------- -- Permit No. _�!.?.�� S �/ (Completes in Triplicate) ------------------ ---------'T•�� ---'- -............. 7� d�-7o Date issued .......... -- _______—__..__ This Pormif Expiroa 1 Year From Dale 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 compipanc with County, Ordinalce No. 549 and existing Rules and Regulations: " F-- � - CENSUS TRACT_.-.-----------' ' JOB ADDRESS/LOC TION . �� --a� L�ru..� -��-'�'-'I`�"" '---- Owner's Name ---. I41�. �1s.«.-.- yC. tit ___ Phone AddressCNYs -!Ly/.�E3.C?- -•----_.-._-----•----..___.._.._..— Contractor's Name ---.LLt1- _. _r.'r'- -- . -.._License# f> I ----- Phone Q .c. -�. Installation will serve: Residence❑Apartment tR,6 3193] Commercial Ohader Court ❑ Motel ❑Other -----ry---------------------------------- Number of living units:-.-�...._- Number of bedrooms _L:�_...Garbage Grinder #.(,1--- Lot Size ...... "'4`---t'"y'"'--""- Water Supply: Public System and name ----------------------------------.._...........—_.....-....._..._..............................Private K. Character of soil to a depth of 3 feet: Sand❑ Slit❑ day ❑ Peat❑ Sandy Loam❑ Clay Laampf-1 , Hardpan ❑ Adobe C] 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 itpublic sseywer is available within 200 feet,) •�� \ PACKAGE TREATMENT [ ] SEPTIC TANK tSize--.3---''t �Z--�-9`;- PACKAGE � - Liquid Depth _--..— �J� �' { Capacity .1-acAc..-- Type MotertalL:"�t -� No. Compartments ....2:f'—.-_»_- ^� Distance to nearest: Well -...��-,�..-----------------.Foundation -�--------•----._.. Prop. Line ..._...---..,..._. LEACHING LINE No. of Lines .---Y--.----. -- Length of each line----1F.t---- ------ Total Length 'D' Box ....1-.... Type Filter Material ----Depth Filter Material --..- {�''�•--- __.......... Distance to nearest: Well 74 .............. Foundation ------ Properly Line --4r........ ... SEEPAGE PIT [ j Depth _------------------ Diameter ------ Number ---------—................ Rock Filled Yes ❑ No 0 Water Table Depth -----------------------------—-------------Rock Size ---—-------------•••------ Distance to nearest: Well --- .................... Prop. Line ...................-- REPAIR/ADDITION(Prev. Sanitation Permit# -.-._.__-.-.............._----........... Date ---_---------------------_) Septic Tank (Specify Requirements) - ----------------............................................ ----------------------------------------I..........—'----.......... 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 fallowing: "1 certify tlyt in the performs a of the work for-.which this permit is issued, I shell not employ any person in such manner as to becor+jubiect to o n' oinpensallo laws of California." Signed -4--4 4 L �.. . I . \. _ - . . t._...-..... By -'--------------.................... .k - t`}--------- Title - ��G ' .a.._-.....----------------------'-- (If other than owner) 1 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------------- .----.------------ ..-..- V _ . ' -. DATE -------- ------- BUILDING PERMIT ISSUED-------------------------------------._.- .-_- .-t,/---------------------—DATE --------------------._............. ADDITIONALCOMMENTS------------------------------------------ - - --------------- ----------------------•----------'---------- _.. - - - - Ffnol Inspection by: .------------'------------'__ Tr3 - . .----'-'---------------'-------------------------•-- -------------------------- SAN JOAQUIN LOCAL HEALTH DIST E. H. 9 1•'68 Rev. 5M