SU0005992 SSNL - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. �9 - (Complete in Triplicate) -6_ _-__-".----� ----- This Permit Expires 1 Year From Date Issued Date Issued -7_G 29---- 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 9rdinance No. 549 and existing Rules and Regulations: w JOB ADDRESS/LOCATION -�- .-6.6L _---_ - _r----- --------- ---90.1" C�,�----------.---CENSUS TRACT ... _._-------- Owner's Name ------ - ---- ------- ---•--------------..`• - PhaneC. Address ---------------- 34- - -� - - -- ----------- ity ---------------------------------------- ... ------ ------ Contractor's Name --- ----..... ...... ..... . - - (2',/(2(,(- 4 �Ci1-------------License # 1 ��__. Phone _ Installation will serve: Residence XApartment House❑ Commercial OTrailer Court ❑ Motel Number of living units:----(_... Number of bedrooms -__��....Garbage Grinder ------------ Lot Size _130_X/70__/__......... Water Supply: Public System and name ------.------------------...._.._-- -_.-----------...... ....Private .. Character of soil to a depth of 3 feel: Sand ❑ Silt❑ Clay ❑ Peat❑ Sandy Loam j] Clay Loam Hardpan ❑.., Adobe` Fill-MgteriaL_-._..-__-If yes, type -------------__-._-_____ r (Plot plan, showing size of lot, location of system in relation To wells, buildings, etc. mustbeplaced on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit'permitted if public sewer is available within 200 feet,) Int PACKAGE TREATMENT [ ] SEPTIC TANK I ] Size-------------------------- -----.----------..__. Liquid Depth _-__-.___.___--_-_____. Capacity Type Material-------------------- No, Compartments ...................... Distance to nearest: Well --------------I__y .....;.....Foundation --- ------------------ Prop. Line _.................... \7� 1 ........... ............._. LEACHING LINE [ j No. of Lines _ ---------------__ _ _-_ __ .... Length}of each line . __ Total Length . 'D' Box ------------ Type Filter Material---------------------Depth Filter Material --._.-___ ------ ..................... Distance to nearest: Well ---_---- -----.-------- Foundation ------------------------ Property Line ............-----------. SEEPAGE PIT [ j Depth Diameter Ijlumber -- Rock Filled Yes C] No ❑ Water Table Depth ...--------------------------------...---------Rock Size -------------._________________ Distance To nearest: Well- : ----------.__......___......Foundation _--__--{______ -- Prop. Line . REPAIR,/ADDITION(Prev. Sanitation Permit# _�___^-_:�_______ _.___--__ -._.-./.�DatejJ__-_..__-__-__J.------------- Septic Tank (Specify Requirements( _-__--__g _ _ - OaCt _s----- - t_- Disposal Field (Specify Requirements) �� --- - --- --------- - - - --------------- ------------- - --- ------.ems -`=*ter--- � --------------------------- -------------- (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, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed - - ----- ------ - ...... ---. Owner �)y�.,. BY - `L/ -� - --- _ . .- Title ------ �`Ef"'.'. (If o1an an owner) O EPARTMENT USE ONLY APPLICATION ACCEPTED BY ----- - __ -- _ __ -- ___________________ DATE -_--- _ - G-ZG - BUILDING PERMIT ISSUED ---- --- --- -- - - -- DATE -------------------- ------------------- ADDITIONAL COMMENTS -------- - ---------------- - --- ------------- ------------------- - - --- - ----- - - ------------------------------------- -------- - --- - - - --------------------------------- '� - Final Inspection b ------------------------------------------------------------- ...Date __ �r A IN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. M