SU0009625 SSNL - Laserfiche WebLink

Home Browse Search

FOR OFHCE USE, APPLICATION FOR SANITATION PERMIT ------------'- s (Completo Triplicate) Permit No. -.7_ .` .4.6 te 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: JOB ADDRESS/LOCATION -----.rZL2 �.�_ + -. ------ ---__CENSUS TRACT ----_------ Owner's Name Name �q LG' Ga4�.i!/ er �'-- - .....................Wtone Address -......-. �.�ft>!1/J----//------------------------------- --------- c -->� �---- ---- Contractor's Name __,4,2 _,4,2 -_t F44L�Y A� ..--- Phonep��li:ll�f/� Installation will serve: Residence❑Apartment House 0 Commerciawroiler Court ❑ Motel❑Other-------------------------------------------- <,— Number Number of living units:------- Number of bedrooms ............Garbage Grinder ------ Lot Size � Water Supply: Public System and name ------------------------------------------------ .......--------- ----------------------.................-.Private] Character of soil to a depth of 3 feet: Sand o Silt❑ Clay ❑ Peat❑ Sandy Loam ]] Clay Loam❑ Hardpan❑ Adobe'J[ 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.) 0 NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet) O 01 PACKAGE TREATMENT [ ] SEPTICTAANK[ ] Size-.�xJLz'.2.x_40- -- ------ Liquid Depth .. Sir.....-,--. Capacity - Type P�ef.GQ_-_IMaterial------- -------------- No. Compartments ---4............ ` Distance to nearest: Well ..... ..........---_----------.Foundation ---------------___ Prop. Line.-_-...... LEACHINGLINE [ ] No. of Lines - _-___--___ Length of each line ./9LF4+-J.-__._.__ Total Length �_—___ IA_ ri 'D' Box __/------- Type Filter Material 1,14XA&.Depth Fiber Material .................. �- Distance to nearest: Well _.Z*-j.--- ._..- Foundation 5d-------------- Property Line ..lQ............. SEEPAGE PIT [ ] Depth ._-._.... ... Diameter . ------------- Number _-._._._--------------- Rock Filled Yes ❑ No O Water Table Depth ---......_...... ------------------...--_ Rock Size---------------••--•---------- .. Distance to nearest: Well -------.-_---------------------- .....Foundation Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# -------- --- Date ....--......._._.____.__.) Septic Tank (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 Scar 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, 1 shall not employ any person in such manner as to become subject man's Compensation Taws of California." Signed ------ ------_----------------.,. Owner By ---_.._------ - - -er- '------------------------------- .._ Title . (If oththan owner) - _ --- - -------- -- FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED --.---.---_----•-------------------..-----__---. ----_---_--.---- DATE---�I--��.---.----------- BUILDING PERMIT ISSUED ......... .----•------------------•--------------------------DATE ._------_------------------------_ A--DDIT-IONAL COMMES- - ---- . — ---- - --.--...�..."..........-.-.-.-.-..'.-............ -- --------------- ---'-..-L.....- ---------- - -----_ — ---......_........'--..._.....-.:--------.......... ..s . . ...... - _- ----- - ---- ------------------'-- ---. . Fin-a- in ' . ..... ' --------•-.------ . SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M