SU0011261 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT S,�n f .. t•9k!.c'.................. Permit No. ...7 .5� -.. a (Complete in Triplicate) : ..aN .Y�.......1.1 30.................. ........................ This Permit Expires 1 Year From Onto Issued Data 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�m./p. de in compliance with County Ordinance No. 549 and existin Rules and Regulations: JOB ADDRESS/LO TIO .:A-/0.....-YI�Lb&9..E.�? (T�,I�S. �........ ..IF .�-.CENSUS TRACT ....................._... Owner's Name .. ............�8/blil9K.eft............._........-.......... Phone ..............................._... Address ......_.. .Cs ../!......,�.XelT70Z................................................ cityrooedk7."PA. -.............................................._. Contractor's Name .... Q.7Q..-/�D.12.�r4/' ................... ..............License #o7NA -3.,.9... Phoney. .2........ Installation will serve: Residence 0 Apartment House 0 Commercial❑Troller Court ❑ Motel ❑Other ..-- .. ..... ......•.................. i Number of living units:........ Number of bedrooms .3.....Garbage Grinderlp-4.... Lot Size rd� 4fs L,9...........:.......... Water Supply: Public System and name ........................................................—..... ..--.........................................Private,® Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay loam ❑ Hardpan❑ Adobe 10 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.)E NEW INSTALLATION. (No septic tank or seepage pit permitted if public sewer Is available within 200 feet,) PACKAGE TREATMENT ( ) SEPTICTANKM SSi`ze....,:irX. ...4............................... liquid Depth J.14............... Capacity l. ...... Typ9yQjA4 sIkF. MaterlaI...................... No. Compartments ..:5k=........... Distance to nearest: Well ......8a ...................Foundation .../A?........... Prop. Line , ......... LEACHING LINE No. of Lines .....1'.. R��.............. Total Length ZW. .. ......... Length of chJli�ne... p 1 :D'•Box.Ys.�,. Type filter Materlalll..Depth Filter Material�d..'1�.................................t Distanceto nearest: Well .-&................ Foundation ..9.0 ............ Property Line .lri`_�......� Sf#.'R fFT jiQ Depth fP............. Diameter f.,,:.%Jr... Number ......Z................... Rock Filled Yes IN No ❑ She/ Water Table Depth ----Af---� - . . Rock Size/ r�............... t Distance to nearest: Well ...../..Aka.....................Foundation ... 7�..�...... Prop. Line .. Of ......... REPAIR/ADDITION(Prov. Sanitation Permit# ........................................... Data .............--.......-..........-1 SepticTank (Specify Requirements) .........................•--•-----....--.....................................•...._.....--....-•----....._.........•••.7---------....... 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 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 to Workman's Compensation laws of California." Signed .................. ( er•... ......._... .... .... Owner By -_..._................ .........:............................_.... 71tle .LPdl� .'.. than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY . .... .. . .......................-.............................................. DATE ......L. ---•-••- BUILDINGPERMIT ISSUED ........ ..... ........................................-.............................................DATE.......................................... ADDITIONAL COMMENTS........ .......................... / }r........... ................................................ . ::::::1 (f- :�/........................................ . ....:::::::::: -:::__:::::: ::::::::::::::::::::::::::::::: ......... ............ ::. .... ........................ ...................... ---- -- .. ......: . .. ....-.... .. ----- -------------•....-......................... FinalInspection by: .. . .. ....-, . .... ...... . ...................................................Date ....1. ..r .......�--...- SAN JOAQUIN LOCAL HEALTH DISTRICT �T2