SU0001217 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: `LICATION FOR SANITATION PERM' ---- ---------- ---------- 1 . /�•(� emit No. (Complete in Triplicate) (\/\�`']\//\ lite Issued -_9"3....... ----- ._-_.....- This Permit Expires 1 Year From Date d 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: I / I $, y7ao.. �.. tZ G�SUS TRACT -------------------------- k . JOB ADDRESS/LOCATION - ...__/��_.-rP-�t7 pn-,w-,- �`�' -- �- ....._ - - Owner's Name -�-4(------.-..1Vg yC --------------------------------Phone -------------------------...---- h�l�4yiQ-- -- ---- --- _ J Address ...--._/p�-fJ�t-- -----45-/--,MAA.�-�/ �/-------------------. City ConTrador's Name -..,A_-�•...Fejae e------ ----------------- --- --_---.License # -e?, .',S p2-. Phone 9273_-: G*V.- InstallaTion will serve: Residence ❑Apartment House❑ Commercial [-]Trailer Court $ Motel ❑ Other Number of living units: Number of bedrooms _42-.._-Garbage Grinder __......_. Lot Size _.._--....:.-__---._-_---------------- Water Supply: Public System and name ---------------- ------Private Character of soil to a depth of 3 feet: Sand]] Silt❑ Clay ❑ Peat ❑ Sandy Loam U 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.) NEW INSTALLATION: (No septic tank or seepage pit.permittedif public sewer is availgble within 200 feet,) 'F1PACKAGE TREATMENT [ ] SEPTIC TANK[ ] Size_. Liquid Dep ... S�s�� 1��J . �. .�_ q 'Q .� Li Depth -J- - -------------- N Capacity JO.."..- _-- Type /:.R�GA�Material.-_----- ..__...._ No. Compartments ---_--a. ------------- Distance -v-f....Distance to nearest: Well __---------.__ --------.-._----F ndat on - --b-_--- -------- Prop. Line ..-._ ....----y--- AA LEACHING LINE [ ] No. of Lines _--_-�___....._.. Length of each line-_ -/Q-d Total Length -2-.CLO 'D' Box .... Type Filter Material L,�/6Jl,4/aDepth Filter Material __.-llff.--.-_-----------------_.--_- yt Distance to nearest: Well . ---------------------- Foundation __.. --------- --- . Property Line ------..-__-----.-.--. SEEPAGE PIT [ ] Depth ____..... ..... Diameter -----_-_----- Number .... .............. Rock Filled Yes ❑ No I] aS Water Table Depth .---------------------...............Rock Size .---------------------- S Distance to nearest: Well -----..-._------------------_--------Foundation .. ----------------- Prop. Line .....-----..........-- REPAIR/ADDITION(Prev. Sanitation Permit# ..-.-.-...._-._._---------------_ -----.. Date -----------------------..---------) Septic Tank (Specify Requirements) .. -- -------- --------- --------- -- 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: "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 subbjjee,�fto orkm//9y�' Com ensation laws of California." Signed ---�.t_'r`-=---- ....'!y, ----_.------------- ------------------- Owner By ..- - -- ----- ----- ----- ........ ....._-- ------ ............ Title ......... -- - ------ - .......- -- .... (If other than owner) FOR DEPARTME T USE ONLY APPLICATION ACCEPTED BY . - . . ....... .... - --- -------------------- -. DATE .....- - �- _7 - - -- -- ADDITIONAL COMMENTS ... -, - - - ........................... ---�--:-BUILDING PERMIT ISSUED ---- �-- 1--.- _-----�.--.----- -- f.°fL/7�'-.-.--- -:: 1------------- - --------------- Final Inspection by: ._......-...v----- -. ------------------------------ --:.-Date SAN JOA UIN LOCAL HEALTH DISTRICT E. H. 9 1•'68 Rev. 5M