SU0012077 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit NO. -l'---'------............-- _..... (Complete in Triplicate) 1 ...... ----------------------- Date lssuecl .3�'��_.2�� .1 0 This Permit Expires I Year From Date issued ---------.................................. W. he Son Joaquin Local Health District fora permit to construct and install the work herein Application isAjr;b�lmode to t ado in compliance with Couniy Or No. 549 and existing Rules and Regulations: described. This ov�licatlon is m 20 . . .....CENSUS TRACT ..... l/V .. .............. JOB ADDRESS/LOCATION ... ix�jr Owner's Name .. ----- _---- . ... -Phone ------------------------------------ .. .... ........ .............. Address .... .......License ------------- Phone ---------------------_------ Contractor's Name .40.0.4-Z�f ------------------ .... ....... / -D�,. 0 1 Installation will serve: Residence Z1446c-j'r�tmen/ouse 0 Commerclkl JpTraller Court I . I � Mctel I]Other . ................................ '4A6'r � r Lot Size . . . . . ........ Number of living units': Number Vdjrooms�Garbage GrInci*>_?F i / i •--'•---- -'- --::...TT----- , - I .....:Private Water Supply: Public System and name --------------- .._ .... ----------- --- . . Sandy Loam E� iciy-Loam 0 of soil to a clei r, Character depth of 3 feet; son�p Silto clay 13 ,Peat 502- if Yes,type .......... Hardp6n E] Adobe C] Fill Material reverse side.) location of system in relation to wells, buildihgs, etc. must be placed on (Plot plan, showl_ngsiii�of�10t,i o . .1 available within 200 feet,) NEW INSTALLATION: (No septic tank or seepage It permitted if public sewer is ova PACKAGE TREATMENT [ ] SEPTICTANKT ] Sizee... --------------- --------......... Liquid Depth _.._.--_---------------- Capacity ..._- ...-------------------- Capacity ----- ---------- ... Type --------------- - Material....... ...... N Compartments --- ........... -- ------------Prop. Line..........I............ Distance to nearest: Well . .. ...............................Foundation ....... LEACHING LINE No. of Lines ......... ----------- Length of each,line... ----------------- Total Length ,...........-.------------ '1 ...........-------------- 'D' Box1 aterial .----------------- Depth Filter Mat rial ... ................................. T .... Type Filter Distanci to nearest: Well .. ............. ...... Fouhclatlon ...... ---------- --- Property Line, _.......------------- SEEPAGE PIT Depth ................... Diame r ................ Number ......................... Rock Filled Yes 0 No C1 Water Table Depth ............ ...................................Rock Size ........... ... Dlstonce to nearest: Well - . . . ...............................Foundation .. .......7tProp: Line ..................... 'Date Ai� .............. ....... REPAIR/ADDITION(Prev. Sanitation Pe�mit#......... --------—------------ Septic Tank [Specify Requirements) ---------- ---------- _ .. ....... ........... ......... ...... Tom _--'.- .......... Disposal Field (Specify Requirements) ......AM.....---AAM_.... ... -I.......................... ............ ........ ------ ........ ------------------------ ------------------- ------------ ---------f..:.. ...----------------------[Draw existing and rekuired addition on reverse side) I hereby certify thcitjI I.--J -_ work will be done In X "havep�repared this application and that the accordance with San Joaquin County Ordinances, State Laws, and'Rules and Regulations of the Son Joaquin local Health District. Home owner or licen- , 3 sed agents signature certifiei,6 following: erfo,, pcof Compensation work for which this permit is,issued, I shall not employ any person in such manner "I cerfif, as to 6.9w i,"bt.�:Ilctpt m, laws of California." O,�vner Signed --- _a-1... Title ------- ---------------- ---- ---- By ----- ........ (If other than owherl FOR DEPARTMENT USE ONLY DATE`:.-:_._.,..T ------- - - ..... ( - - ---- APPLICATION ACCEPTED 13Y DATE_ BUILDING PERMITISSUED-- --- ---------- ........... --- ADDITIONAL COMMENTS ......... .. ---- ...... ... ..... ...... .................. ............. ----- ........... .... .. .... ....... . Final 11 s e SAN JOAQUIN LOCAL HEAtTH':OISTRICT- E.H. 9, 1=68 Rev.6M.