SU0006560 - Laserfiche WebLink

Home Browse Search

rvx.UVNF :t: U5t:: / PIRLICATION FOR SANITATION PE RRAIT ........ (Complete in Triplicate) Permit No.��:_, F,5.1 . This Permit Expires i Year From Date Issued 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 lin compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ..-. -..r. .- `-- ... n'' --- ^.. .............CENSUS TRACT ..... Owner's N e ---.cm 6 IS---- -------r f ZG-een. f. �.. .............................................P Address .... -- �� /Y1. 1 f A Phone ... �`�'" .��/ $ - -------- ----------OJ !r�`�� City .. C' ? rJ I Contractor's Name -.---•- �:G+ - �y ............................ ...............r._....__ Phone . ._._...' Installation will serve: Residence❑Apartment House Commercial ❑'frailer Court � Motel El Other ---�Y .*�I#i Ra_'("r'7 ........ -•-- ......... nn Number of living units_____________ Number of bedrooms _.--------.-Garbage Grinder ........::._ Lot Size 1.__. 0 ...................... Water Supply: Public System and name ____ _ __ k - ---- --------------•---_....---.._......------------•-... __Private Q r Character of soil to a depth of 3 feet: Sand---- Silt Q Clay [� Pea#[] Sandy Loam ❑ Clay Loam 0 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.) N NEW INSTALLATION: (No septic tank or seepage pit permitted If public sewer is available within 200 feet,) LSI PACKAGE TREATMENT [ ] SEPTIC TANK f ] Size__.-`�.j_X t v ,-•,r`j'- --_ Liquid Depth .- .. u0 69� CE'Me�T ------•-•- . Capacity --�------ - ype ... ----- Material-_. ---- -• ...- No. Compartments ....... - .......... Distance. to nearest: Well -----jO(�-�_. -• /00Prop. Line ... - .....:... ---•----•--•----Foundation LEACHING LINE No. of Lines ...__.!_------------- Length of each line.--•--.+70.I____.._--... Total Length -------r��1 ... ` ......... 'D' Box ---- ------- Type Filter Material ...?./ ---------Depth Filter Material .._._.i ----------- -- ................. Distance to nearest: Well __-.�0G _-.- Foundation -------------- .....__ Rock Filled Yes ❑ No L ) depth ----- ------------- Water Table Depth ................ -.--Rock Size ................................ Distance to nearest: Well .............•................ ---------Foundation ---....---------.... Prop. Line Sanitation . } ......_.•...... RIIRADD�TION Pre Permit . ..•--------_--•....------ Date .........-................. ...... .Septicl p CfyRequirements - ••.... .... .. -------------•------. _ —........... .•_---- I ..........................-......... . Disposal Field. (Specify Requirements) ___----------------- IN ----------------- ---- ---------------•----•---- ----'------------- ----•------•--------------- ------------------------ (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 Heafth: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 --------- --------- Owner ---------- By _.... �t' --------- -- -- ---------- Title °--- -- (If other than•ownerl i OR DEPARYMENT U E ONLY APPLICATION ACCEPTED ---------- DATE . 9 .. BUILDING PERMIT ISSUED -------------- :.---_--- ADDITIONAL COMMENTS ------ ...........DATE --------- - ------------------ -------- _ .---- ... ----- _- ::---_ -: _ .. -------- - .----- - -------- -•-- Final inspection by: --------------------- �e� r_ /---- J" - ---------- Date - ... ... . �. ...-- ..__......lei Z3 2!t 1--68 Rev' 51'1AQUIN LOCAL HEALTH DISTRICT I 8/7h 3M