SU0005179 SSNL - Laserfiche WebLink

Home Browse Search

' FOR OFFICE-OSE: APPLICATION FOR SANITATION PERMIT >. # ...... ........ . . ... . .... . Permit tJo. ...�3..-1'r•!.>� r _ _ (Complete In Triplicate) Date Issued ..�—..210 -7� ... This Permit Expires 1 Year From Dote Issued compliance thJtInstall lt he work herein Application is hcs the iDistrict described. Thsappliatonimodon wiithCouyOrdinaneNo. 549 and existing Rules and Regulations. JOB ADDRESS/LOCATION 5.7dU.. �� "'� - `r- """ ....CENSUS TRACT ._ ..... Y Owner's Name GL '!•5 ......................... ....; ..Tt. f Address '7 c? � �'�d"Tl-! - ..: ................... ............. ....... - ...... CT ....... -�✓..��,,. yry License # .R Phone y......./a .: �.�.v Contractor's Name...— ........ Installation will serve: f:esidence�Apartment House Commercial (]Trailer Court Motel ❑Other................................. .......... Number of living units:...... . Number of bedrooms ... ......Garbage Grinder ............ Lot Size Q�rJJ.t--.---•- WaterSupply: Public Sy . .........................Priv X ate .t em and name C] Ado❑be� Fill aterial ............ i]....... If yes,type....----..-Y.-...." ❑ side. Character of soil to a depth of 3 f,•et: Sa::d Silt ClayPeat Sand Loam Clay Loam k (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse ) p { NEW INSTALLATION: (No septic tori or seepage pit permitted if public sewer is available within 200 feet,) df PACKAGE TREATMENT ( I SEPTC TANK( ] Size....................................... .. Liquid Depth .......................... Capacity . T Material...................... No. Compartments ......-.-_......-..... iP Y ......._.......... Type .................... tDistance to nearest: Well ...................................Foundation ................ Prop. Line..................... ; No. or Lines ........................ Length of each line............................ Total Length .......................-...- 't LEACHING LINE [ ) - -. . 'D' Box ............ Type Filter Material ....................Depth Filter Material .._........_............................... , . .. Distance to nearest: Well ."...................... Foundation ........................ Property Line ...... ............... Diameter Numbe: .............. ............. Rock Filled Yes ❑ No C3 , i SEEPAGE PIT Depth •••••------ Water Table Depth .Rock Size "............................... ................._............................ 6' Distance to nearest:Well . ............................. .......Foundation _.................. Prop. Line ...................... ... REPAIR/ADDITION(Prev. Sanitation Permit# ................ .............................. Date .................................1 j ,. Septic Tank IS edf Requirements) ._...._....... r ................ ..... ...... /---.-.. .. ........t................. Disposal Field (Specify Requirements) "- - " Q�-It:.-....14 � ../1ah`f�:.......�.:•. � cc..............._ ; (Draw(Draw existing and regmrdd 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. Hems owner or Iicen- 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 bec/q{�na su- loc/t to,Woo moms Compensation_IoJvs of California:' Signed ........ Owner . ._............ .. . ....... L� 1,/ �f li.: t�✓ ..- Title __._. . . . By ..._......_.._. .. .... (If other than owner) FOR DEPART M NT USE ONLY '��.. ... . '� __._.__.. ...... . . DATE .$"_�iZ.ay-...:....:..7 ..... APPLICATION ACCEPTED BY.. .�". %-f .. ...........................DATE ........................................... BUILDING PERMIT ISSUED .._................."............... ..........................._....... . ADDITIONALCOMMENTS .. ................................................................ ....."............."......................................... q . ... .. . . .. ...... __.. ............... . . .. ...... .... . .. �.. rr. - . . .. .Date V ?.6. ... -. Final Inspection by. ... ..... .. .. .. .. SAN JOAQUIN LOCAL HEALTH DISTRICT E.H. 9 1-'68 Rev. 5M ,. 11