SU0003962 SSNL - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: '%APPLICATION FOR SANITATION PERN111 6- I— I �' / 0 _' - . .._ _... - -.... --- �� (Complete in Triplicate) Permit No. .. . ........._--. This Permit Expires 1 Year From Date Issued Date Issued .17!.y.:.7. Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application ism d in ompliance with County Ordinonc No. 549 and existing Rules and Regulations: JOB ADDRESS/LOC ATION -_...._ _.- - CENSUS TRACT _.5 l�_............. Owner's Name _. _ 1'1_ _.. ---------- ------ --- n Q f�a Address . ..- - ..�.(! .��d— City Phone -- p Contractor's Name _.- - .._ .. _ .. __ •-- .License - .O-Y Phone -------- _ Installation will serve: Residence partment House C] Commercial ❑Trailer Court S Motel ❑ Other ..._ __ -------- -------_------- Number -- -- --Number of living units:_..-I... Number of bedrooms -3.....Garbage Grinder .. ...... Lot Size ..... -- Water Supply: Public System and name ----_--------__------------------_- ------------ --------------Private [t}� Character of soil to a depth of 3 feet: Sand [] Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam j$ Hardpan ❑ Adobe ❑ Fill Material __. _ If yes, type -----.__------- ..-.-_.. (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) I' —PACKAGE TREATMENT [ ] SEPTIC TANK{ ] Size_ r�.X---1-0-'. JC _� " Liquid Depth -.4, .A '--...---- Capacity _._ Ca act /t ,, ' 'r1 P h' -1.�-06.--._ Type ._.__...._..... MaTerial_��-rscv�.No. Com artmenis Distance to nearest: Well __...._.54_x..-..___--Foundation/-__�.�..�_ . - Prop. Line -_._:5,-_.'....- -LEACHING LINE [ No. of Lines - ......�.____. Length of each line.- ... ` 9 +1� - �.Q-G......_.... Total Length --�_V-3'_�_--------- 'D' Box .._. --__.. Type Filter Material -S,R.r__Depth Filter Material ' Distance t nnearest: Well _._..5'0-.f----- Foundation _ 1,0_1 Property Line -.5...---..._...... SEEPAGE PIT rix Depth . - c;VZ71_ Diameter ..._'`Number _._.-....cR.---- _- Rock Filled Yes No Q Water Table De th ^ N p ____------_.-7-a. -------._------Rock Size __ . Distance to nearest: Well __._._..._-b.8. ?_�_.._-,---Foundation -..._-fd_�,-_- Prop. Line -----7--------- REPAIR/ADDITION(Prev. Sanitation Permit# --- Date Date __----------- ------.___..-.-_) r Septic Tank (Specify Requirements) _._.___..._---- ---__.-_ -----------.__-. --- ------ Disposal Field (Specify Requirements) --.-------.-------------------------------- --._-.......-... ----...------- ----------------- ...... . .........-._.-------------------........ --- ------ ----._--------------------------_.__ - -------- ---------- ---- 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 ,1s to become subject to Work Compensation laws of California." Signed - -. ---- -. /G _. --, Owner ly _ - .. .. ----- _. _-l�/Lt4S?af �J Title __ (if other than owner) FOR DEPARTMENT USE ONLY 4PPLICATION ACCEPTED BY ----lam ... ---------.-.-------- .----------------. DATE "BUILDING. PERMIT ISSUED .-,------ -------------- ----------------------------------DATE ------------ - ADDITIO NAL COMMENTS . - - -- - ---- -------- ---- -- ...- ----- --- ... -- -- - -- - -- _ - --- ---- - - .._.......- ------ ------ -----------------------------...........-------------------- _-------- - - ------------------------------------------------ - ----------- -- --- - - -- -- Final Inspection by: ------_ ------------ -Date -_-- SAN JOAQUIN LOCAL HEALTH DISTRICT —