SU0003637 - Laserfiche WebLink

Home Browse Search

�I f ..."•'. .rte APPLICATION FOR SANITATION PERMIT ...................... M---.......-- --- 'Complete in Triplicate) Permit No/,�,-,0, - ' p' Date 1 A+ fe Issued - 'Application - o This Permit Expires 1 Year From '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: JOS ADDRESS/LOCA ' F <� - ------------- •-------- --- - ------CENSUS TRACT .._ Owner's Name .._ ------------•-•------- :. ----- ------------------••-----•--•------- -- -- -- ------------Phone-------------------- Address .............�. ,. _ f. wontractor's Name_... x�- ..�x, _ r z�. Jig -`-- ---•--------•------- -•----License # _.1 .°�'nstallation will serve: Residencertment House-E] Commercial :E]Trailer Court 0 hone ---------------------•-_.._.__ Motel [] Other ----- qum er Nateb Supply:livingunits + umber of bedrooms '-.Garbage Grinder ------------ Lot Size PPIY Public Systemand name _.. Private :haracter of soil to a depth of 3 feet: Sand '[] Silt 0 Clay E] Peat❑ Sandy Loam Clay Loam Cl Hard an Adobe Fill Material p ------ If yes, type ------------------ Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.] JEW INSTALLATION: (No septic tank or lseepage pit permitted if public;sewer is available within 200 feet,] ACKAGE TREATMENT [ ] SEPTIC TANK --• •.----•--- -------- Liquid Depth ----------------------• Ca aci ! ' • tY --------------- Type •-----------,Size Material ---------------------- No. Compartments ------------ --- Distance to nearest_: Well -.---- -- Foundation ---------------- ----- prop. Line ------------------ %1101 :ACHING LINE [ ] No. of Lines ------- Length of each line---------------------------- Total Length N D' Box --- _------ Type Filter Material --------------------Depth Filter Material ------_-_-- Distance to nearest, Well ------------------------- - -----�---- ------------------ -------•----.---- Foundation -- ------ -- ------- Property Line i PAGE PIT - [ ] Depth ----------- ------ Diameter ---------------- N I Number ----------------------- ___ Rock Filled Yes � Na jo Water Table Depth -------------- Rock Size -------------____-- Distance to nearest: Well ----------------__ ---Foundation -------------------- -------------------- Prop. Line -------•--------...._. :PAIR/ADDITION(Prev. Sanitation Hermit # --------_------------------------------------- Date ] Septic Tank (Specify Requirements) ----------------------------- --------------------- Disposal Field Specify Require eats] .._ __��.,_;Gc �,— l� Y `,�-� i. ---- -------- --------------------------------------�----------------- -i------------------------------------------------------ -------------------------------------------------------------------------- (Draw existing and required addition on reverse side) tereby certify that I have prepares! this application and that the work will be done in accordance 'With San Joaquin unty Ordinances, State Laws,'and Rules ;and Regulations of the San Joaquin Local Health District..Home owner or licen_ agents signature certifies the following: i i certify that in the performance of the work for which this'permit is issued, I shall not employ any person in such manner to become subject to Workman' mlpensation t f California." ned --- ' Owner ---------------------------------•----------- ( L�j�itie -----5 _,{�].� other than owner] t ------------------------------------------------ f/ F��ENT USI: ONLYPLICATION ACCEPTED BY '-- - _---- --- --------- -------------- - lLDING PERMIT ISSUED ----- - DATE - ------ - - -------------------------------------- --------- - -- --------DATE ----------------------------- - T10NAL COMMENTS.----------------=- ------- -•--- ---------- , - ------ •-------------------•-. - ---- ------------=--- --------------------------------- aE Inspection b . - -----------•----------•---------------------------------- -------.Date --- ---- 2------- - SAN JOAQUIN LOCAL HEALTH DISTRICT 1. 9 1-'68 Rev.'5M