SU0005852_SSCRPT - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION POR SANITATION PERMITPermitNo. . -- ........................... .. ._'....-... .. (Comple»In Triplicab) ..................................................... This Permit Expires I Yew From Data Issued Date Issued Z:- Application :Application is hereby made to the San Joaquin Local Health District for a permit to constrict and Install the work herein described- This application is made in compliance with +County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATI - � kC GC�-. .......................................CENSU S TRACT ...... ................... Owner's Name ... .... { t J, (� --' - - .......... ... ... .. . .. ... YCv.3.a ��/ � Phone . - Address �.�- - - City�cJ< 11�iiJ " "- [J �y _... Contractor's Name --- :.J�l•..... .L t� t t . -...-- -----..License 4F .71�?`l/.... Phone - Installation will serve: Residence W Apartment House Commercial QTrailer Court Q Motel ❑Other............................................ Number of living units:-----/-... Number of bedrooms ...._Garbage Grinder ..... ...... Lot Size Aazyll bed ............. Water Supply: Public System and name --------------------.............................-......................... .--.....Private Q U Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam [] Clay Loam ❑ p Hardpan ❑ Adobe Q Fill Material ............ If yes,type ............... ............ t3fc (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse sldeX NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ I SEPTIC TANK f ] Size................................................ Liquid Depth ..................._..... Capacity ...----------- ---- Type ----------------. Material.........-........... No. Compartments ...................... Distance to nearest: Well ------------------- ----------------Foundation ..---................. Prop. Line -____..........__... 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 Lino ........................ SEEPAGE PIT [ ] Depth Diameter ................ Number ............................ Rock Filled Yes ❑ No Q Water Table Depth ...... .........................................Rock Size ............................. -- Distance to nearest: Well ........................................Foundation -----...-_..._...... Prop. Line _--_--_-___---__---- REPAIR/ADDITION(Prey. Sanitation Permit# ............................................ Date -...............................I Septic Tank (Specify Requirements) ........................j l.`.......-..-•---.........._._.......-®®®__ _..---_-_-_........-........ Disposal Field (Specify Requirements) ..-- --- - ------------------------- - - -- --- ---- ------ -----fix ---...... •-------------------------------------------- -- . ----------------- .............-...................... ............................ ........-_............................. (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 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, I shall not employ any person In such manner as to become subject to Workman's Compensation laws of California." j- I Signed 1 ------ . . .... Owner By `.�.a�.. ... . .. -- �1.. ---Title - _... .. . . _.._..__.. -._. ........-- (If other than ner) FOR DEPARTME T USE 9NLY APPLICATION ACCEPTED BY . ... .. .... --- - - -------- - - - :... OAT E - 15 S- ... . BUILDING PERMIT ISSUED ...--- - .._... - -.............. - ...... - ..DATE - _ - _..-.._......._.............. ADDITIONALCOMMENTS ... - - -- - - - ... .... -.............................---- -- ._ _.. . - --------- ................ - ...._ . _. - . y t� 4 Final Inspection by - -... .- . . - ------- Date 1i . !✓.. ... EH 13 2h 1-68 Rev, !N SAN JO IN LOCA HEALTH DISTRICT $/7h