SU0004256 SSNL - Laserfiche WebLink

Home Browse Search

r FOR OFFICE USE: `wo -• ( APPLICATION FOR SANITATION PERMIT (Complete in Tri hat*l Permit No. .7v-. °3 .--........-..-.--..... .............................. This Permit Expires I Year From Dat*Issued Date Issued..6n.�5..-.24- -- Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This apr,)ication is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ---f....F.3L.........All..r2.!J.�.... �.G .... .. ._...... ... ....CENSUS TRACT .......... Owner's Name ... h.G"..49...,: ............................................... ......................... .Phone......... Address . ....... ..!'�'s?7 C .:. ................ City �t!?..G,y ..... .... � s Contractor's Name .. " ..e k;. .......... ... ........... ...License Installation will serve: Residence[$'Apartment House❑ Commercial ❑Trailer Court 0 - Motel❑Other Number of living units:.. ..... Number of bedrooms —:: .....Garbage Grinder/tom Lot Size /'.ZJ-X.ZL. 0..� Water Supply, Public System and name ........................................................_...................................................Private$(. Character of soil to a depth of 3 feet: Sand 1] Silt❑ Clay ❑ Peat❑ Sandy Loam J9 Clay Loam ❑ Hardpan❑ Adobe ❑ 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) i NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) V- .PACKAGE TREATMENT [ j SEPTIC TANK[ 7 Size..........._............ .............. .... Liquid Depth . Capacity .... ............... Type .................... Material............. No. Compartments Distance to nearest: Well ....._---......................Foundation............._. ...... Prop. Line....................... Jpf� LEACHING LINE [ ] No. of Lines ........................ Length of each line..... ...................... Total Length - \ 'D' Box .....- __. Type Filter Material ....................Depth Filter Material ............................................ + Distance to nearest: Well ........................ Foundation ........... ........... Property Line ...............:::...... - `I SEEPAGE PIT [ ) Clepth .................... Diameter ............... Number ............................ Rock Filled Yes ❑ No 0 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) --.....c7A�.11 .......-feel. .�. .../a..------- . ..... ...-- n ....._...._............ ......................_........ ................................................................................................................. _ .... ........ .... ...._...............- ._................. .. ... .............................. ---------.................................................................. .... (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work will be dens in accord anc�ee with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health Distrier!Home owner or Ilan- sed agents signature certifies the following: - "1 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 become subject to Workman's Compensation laws of California." t Signed ......?, W,—no .. ./....... j.. . .... .. . .... Owner By . owner) FOR DEPARTMENT USE ONLY APPLICATION BY .. . .. - .. le../L:. Y� IL f/ , DATE..(� /I �s..� ACCEPTED u................ - f BUILDING PERMIT ISSUED ..... / / ... DATE .. .......... .... ! 1 ADDITIONAL COMMENTS. _.._. ..... .. . . .. . ._ . .... ... . .. . . ... . ._. __.. _. _... ._.. _... .. f rU .,(�/. .. Date Inspection by: . t n �..r.y..i.c].. SAN JOAQUIN,,L9CAL LLE LTH.ISTRICT E. H. 9 1-'60 Rev. 5M