SU0005937 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT r (Complete in Triplicate) Permit No..__7. S Date Issued_ ..............__...._-._.... ----- 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: Owner's Name---y�� _ O-_-- l'o' - CENSUS TRACT.. -- 4- ----- - .2G� / ----- -- - - - - JOB ADDRESS/LOC N...�7.-. z`da+ -- ---- ---- --------- - e Address_.. - - - ( . ?Y" C' �d�4 r Zi P O .......... - - - p /9 pY Contractor's Name... .- -- _ .___-___. - .Etter'•"......-___._.__...__License #-� 7 /5 _.._Phone-�E7.�OW installation will serve: Residence 2-�Apartment Houses] Commercial ❑ Trailer Court ❑ Motel ❑ Other---------`---------- - Number of living units-------------- --Number of bedrooms_3-._.Garbage Grinder------------Lot Size ------- .-----.._------.-__.------ Water Supply: Public System and name------ ------------------------ -- ------------- - -------------- --- ------ ----- --------------------------Private jn► Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat❑ Sandy Loam L45--f-lay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material------------If yes, type___---------_--------------- (Plot -__.-..._.............(Plot plan, showing size of lot, location of system in relation to wells, bvildfrkgs, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or "s�e�eppoge pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK I-1' Size.__s Y Is- A 914 ZA �y ._...--------.Liquid Depth.-_ /� � Copacity--� Type-- ----------Material-_. --No. Compartments------A------------------------C r Distance to nearest: Well-----— _2.5�----..----._-..._ i.-----Foundation.. "?_____........Prop. Line._�r __....._ 6 LEACHING LINE [Ar No. of Lines--------3-----------------Length of each line___174/Qi-�..-__.-:Total Length.__---- 'D' Box_!Y~_Type Filter Material_/_X/'??�--Depo(Filter lterial.. X rt r FoundaTlJon_ -4_rs Property �j�d Distanceto nearest: Well � . . .. �l IT,.- line. SEEPAGE PIT p'r Depthow"' . .Diameter a33-e ...Number � -- Rock Filled Yes F4-No❑-) Water Table Depth--------*_1_----_-------------------------_ _-._ Rock Sae / �.� -.3 0 O �---- ------ Foundation_�s--�''/ ...Pro Line.- �J/D Distance to nearest: Well....-..f 7 _ ( r�--------•- P• - REPAIR/ADDITION (Prev. Sanitation Permit#----------------------------------------------- .[late r r __ -------- Septic Tank (Specify Requirements).-_. --- --- ------------------� Y Dis osal Field (Specify Requirements)---------------------------------- ---------- ........ ....... ' .. _______ __________ .. . F -.. t _ ` - 9 q - [Draw existing and required additionron ieverse side) I hereby certify that I 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 licensed agents signature certifies the following: _ "I certify that in the performance of the work for which this permit is issued, I shall ndf'ornploy any person-in_such manner as to become subject Workman's Compensation laws of California." G. & C. SEPTIC TANK SER. Signed - -- Owner P. 0. BOX 94 / _-- A BY - - . Title +4camPo;C31tf 35120 (If other than owner) F2F DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ,C�c ------ -------- ------------------------------ DATE__-. �I ----------- DIVISION OF LAND NUMBER.--------- ------- ------- -------------------------- ----------DATE.--- ADDITIONALCOMMENTS-------------------------------------------------------------------------------------------------------------- ------------------------ -------------- ------------ ------------_ ------------------------ -------- '----------------------------------- ------ ---------------------- -------- .-._...---------------------------------------------------------- -------------- ----------- ---- ------- -_----------------------- - ----- - - Final Inspection b 97 P Y' - - - -/- -- - - - - - - - -- - -- - _._-Date --�� g - - - - - er 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&S 21677 REV. 7/76 3M