SU0005955 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: rPPLICATION FOR SANITATION PER ---- (Complete in Triplicate) Permit No,. ----- This Permit Expires 1 Year From bate Issued Date Issued Application is hereby made to tWSan Joaquin Local Health District for as permit to construct and install the work herein i described. This application is made in compliance withCountyOrdinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION . �/ / TRACT -------------- Owner's Owner's Name ---------._----------------_ -----Phone Address ----_-- -_ t, I / � 3C -- - - - City --- �1 /- Contractor's Name --- -- t- -----.License # a?.5- /7,. - Phone -----------------------•-------______ Installation will serve: sidenceXApartment House-[] Commercial:❑Trailer Court ;❑ Motel ❑Other Number of living units!--- ------ Number of bedrooms ._......Garbo e Grinder ------------ Lot Size ter--- ----- Water Supply: Public System and name ------------------ ------- ------------------------Private Character of soil to a depth of 3 feet. Sand'(] Silt 0 Clay ❑ Peat❑ Sandy Loam 1] Clay Loam❑ Hardpan Adobe'0 Fill Material ------------ If yes,type ---------------------------- (Plot _____________________ __(Plot plan, showing size of lot, l k ation of system in relation to wells, buildings, .etc. must be placed on reverse side.] OQ NEW INSTALLATION: (No septictank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ SEPTIC TANK:[ ] Size-------- X..!F_ ______________________ Liquid Depth __--- --�..I� oa No. Compartments ...... NCa Capacity -� _0_____ T Material--- Distance to nearest: Well ------ f ____-___Foundation ----l_•-----_-__ Pro Line .__ LEACHING LINE [ ] No. of Lines ___ ______________ Length of each line--_-_/GfQ-----.------ Total Length 'D' Box Type Filter MaterialDepth Filter Material ------/lop _ -----________ _ -- Distance to nearest: Well _- , 0_-•-_-___ Foundation ----/0 Property Line ,� e SEEPAGE PIT [ ] Depth _�__ __- Diameter --- .. i - ____- Number -------�__-_____�_ RockFilled Yes Na 1❑ Water Table Depth ------- - ---------------- Rock Size _ X_�__L Distance to nearest: Well _-___ 'L Foundation Q. --_-•---- Prop. Line ----- --___-- REPAIR/ADDITION(Prev. Sanitation Permit# ...----------------------------------------- Date ---------------------------------- Septic -________•___________ ___________Septic Tank (Specify RequiremenS) -------------- Disposal Field (Specify Requirements) -------_ ------------------ -------------------------------------------------------- ---------------------------- (Draw existing and required addition on reverse 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 licen- sed agents signature certifies the following: "I certify that in the performance of..the work for which this permit is issued, I shall not employ any person in such manner as to becorn ct to WZFKmqn9 JCompe ation laws of California." Signed _`' ""` i Owner BY ------------- .� ----- -- -- ------ Title ---- _ .- (I other th o ed i - P )ENT USE ONLY APPLICATION ACCEPTED BY - ------ - DATE __-_ BUILDING PERMIT ISSUED ----------- = DDI7fONAL COMM NTS _.-_____ -_� _ ---------•------••------------••----------- ----------------------------DATE -- ------- •-----------------------•------- ----------------------------------------•-----------------------•------•---------------------------------=--------------------------- W-.7. + -r----- ---------- ----------- --- ----- t -- - --------------------------------------------------------------------------- --- ----------------------------------- -----=----------------------- Final Inspection by: -- _-- -------Date ------� -- AN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Re 5M