SU0005992 SSNL - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PER N}I ) 71 7- s:.----------------------------------------------------- �_(`/ i / Permit o..---...-_..------ -- (Complete�r Tripl' ate) -_._ ------------- ------------------.... ---- -- �,. ,7 �a sued - - -....7 -..--------.--...---......---------__._...___.... This Permit Expires 1 Yea Fro r Application is hereby made to the San Joaquin Local Health District for permit to construct at( s all the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION.../( s......... (F[ RcI•_...�00----1G.p/_ JACk_ ORAE------------------ - CENSUS TRACT-------------------------_ eye r --( "---- Owner's Name----- - -- -----_-�` --Q.ZA-le _ -- --------------------------------------- P one- Address............... r ----- ---- - -yam✓+- �L/� - - - - �`l -----'--'"."""" -----city----.�'..G-l.'to`-'-�f"�-----------[�"'ziP----- --`---------------.. Contractor's Name-W--- ( 'M-- -- F" 'f .: - --- ---.-----_--_-__-----_.-License #... 'J.?_,,2q?�thone-------j.16-:2`tef Installation will serve: Residence TiG Apartment House 0 Commercial ❑ Trailer Court EJ r (Motel ❑ Other--------------------------------------------- Number of living units:------ _._._Number of bedrooms__S...Garbage Grinder-----./_.Lot Size._ -------------__.-...__.--------------------------_-G Water Supply: Public System and name ------------------- -------------------------------------------- ----------------------Private r Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ G Hardpan ❑Hardpan Adobe Fill Material_------. -If yes,type____-----...__.._._Material_------.__If yes,type_ _ -_....___-- _- ( -(Plot plan, showing size of lot, location o7 systern__n relation to wells, buildings, etc. must be placed on reverse side.) lJ� NEW INSTALLATION: (No s+ic tank or seepke pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT` [ ] "-SEPTIC TANK -----Size:::- _ 0-r9`_: x_---Liquid Depth-- -- _..-. -- Capacity---tAY e._..._...._._____.Material_C t_No. Compartments---------Z....-------- _.._�� Distance to nearest: Well..---IL0-C9-___._..____. ---------Foundation...._._.1.S? _.___.Prop. Line----80.'...___ _LEACHING LINE [ ] No. of Lines------------a---.--------- Length of each line___8r:_ -------------Total Length ..._. -------- ------� _. _._ 'D' Box_%-5----Type Filter Material..Szt2 __-Depth Filter Material-____Lis-............. Distance to nearest: Well-----f4�------------Foundation-------'zy-------------Property Line-..__.-----------...._. -SEEPAGE:PIT [ ] Depth---2a§_ -----Diameter.-----�3_-----Number-------------A---------------- Rock Filled_ Yes (ate No Water Table Depth-----------------J'DQ_'..._---_-----------------Rock Size-------------------------------------- - Distance to nearest: Welli...__.._-- ' :-_�"-`-.__..___._Fo"iinda?ion------I ?_.____...Prop. ,ine__.45v_____._... REPAIR/ADDITION-(PAN! SanttationPermit#--------w----------------_------------------------Date----i L_....._.----.------------------------.) Septic Tank-(Specify R1gquirements)-------------------`_`-------------------------------------------_._- .._- -""`-= `=`----'-_ `Disposal Field ISpecify Requirements)....------------- -- ---------------------- ------i- "---- ": -------------------------------------------------'---------------------- -------------------------------------------------------------------------_.. T I (Draw existing and required addition on reverse side) I hereby certify that 1 Ihave 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 licensed 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." Signed t. - - -- -Owner By-_ Title..�.W''L�tiS IR' ----V- �� J r (If other t an owner) FOR DEPART ENT USE ONLY APPLICATION ACCEPTED BY------------------------------- ------ - - -- ---------------DATE.----12-77-7.7..--- - so DIVISION OF LAND NUMBER-------- ---------------------------- ------- - - - -- - ------ - -DATE.-------------------------------------------- ADDITIONALCOMMENTS-._------------------------------- ----------------:------ - -------- - - ------------------------- ----------------------------------------------- - 1.------------------------------------------------------------ ------------I----------------------------------------------------------------------------------------------- ---------------.....--------------------- ------------------ -------------------------------------------------------------------------- ---------------------------- --- --- ----- ------------ Final Inspection by----------- ----------- ----------- ------------------------------.Date----------------------------` EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&5 21677 REV. 7/76 3M