SU0000537 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION FIRM . ... ...... ..... (Complete In Trip Iceh ....................... Doh Issued This Permit Expires 1 Year From Daft Issued Application is hereby made to the San Joaquin Local Health District for o permit to construct and inttoll 1lso went hoose described. This application is mode in co �111107 lia ce wl County Grdlnonce No. 5I9 and existing OW" and MRuIOMOM JOB ADDRESS/IOCATIOt O OS ; �Q t J ... . ►Irons .............. ......•- Owner's Name .... /`-►'..�'.0 . '..!... ...... ........ l � Address �- 1 . �U Ci «.«.....««.......,. Contractor's Name-*..e--�!(��.�w..wR . t !et"�4lconsa I Phone, r..»•»�•»� - Installation will serve: Residenceg Apartment Homwo Cornmerclal ❑Traitor Court ❑ Motel ❑Other. .......... ..._. -.. .. ............... Number of living units: / Number of bedrooms j_....Gorbag* 00nder -. Let we •..amu-�y�- -- Water Supply, Public System and name . .... .I......»...— -11-1 .......... ,« «..»....,..... .......... _hNvN,j�' Choroctw of toll to a depth of 3 feet: Sand Q Silt Q Cloy (] 'oat❑ Sandy Loam 0 Clay loom Hardpan Q Adobe U Fill Material Af yet.type_- (Plot pion, showing size of lot, location of system in relation to wells. buildings, eft. mutt be placed an mom §W9.1 NEW INSTALLATIONt INo septi: tank or seepage pit permitted If public sower Is available within 200 190J 0 PACKAGE TREATMENT ( j SEPTIC TANK( j Size -- • Licruld aP* ••••••» -» ~• - ^ Capacity Type Mtaterbl No. Canparowmft O t Distance to noaresh Well ... .. ...Foundation LEACHING LINE ( j No. of limes . Length of each line Told length «........... 'D' Box Type Filter Motorial ........»........Dept!► Filter Material ......... Distance to nearest, Well ..........«.«....... Founclailon .......».....«..,.. . Property tiers .......».»... ._... SEEPAGE PIT ( ( Depth Dlametw .........»«... Numbs• ........ .<..... Rods Filled Yes ❑ No (:I Water Table Depth .. »«».»...,.......Rodt Size ..,.,..«.».............«... Distance to nearest, Well ..................................»...Foundatlan ...............«... hep. Lim ..... ...__........ . , REPAIR/ADDITION(Prev. Sanitation Permit ........... ............................. Doh ..,........ Septic Tank (Specify Requirements) .... ... ............................................»....»........................»................_............ _... Disposal Field fSppeecify Requirements) .... ....................................................................................................... . ......�.. ................lr (Dr?1sapplicalion sting and te� addition ►overso side) hereby certify theft I have prepared and that the work w1TI be dene In accordance wNis Sew J61111111rlw County Ordinances, State Laws, and Rules and Regulations of the Sen Jo"win Local Health DI$Mct.Moran awswr er Elaw- sed agents signature certifies the following: "I certify th-it in the performance of the werk for which this permit is issued, I shall not employ env person M ends n 8mw as to bet subject to Workman's Compensation laws of California." Signed _ . ...................... Owner By C`J.._ ......................... Title . 'ef? . .................... (if other than owner) 'DR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ....... ................... .......... .... ................... DATE 6.1:-1170Z...................... BUILDINGPERMIT ISSUED _.... . .. ..............................................................................DATE ....................................... ADDITIONALCOMMENTS .....................................»............................................ . ............................................. ..... _.. ................................................... —............... ..-..............-.. ......... .. ................. 1 .. ............ _........... ...... ..........................-......................... Doh / X-✓/::! Final Ins {on b ;�r�-z.c�-r�•�'.. ..... ..... ........... Pact y: __... ... .__ ..................• - ... ...... ...... SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'G8 Rev. 5M