SU0004756 SSNL - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: 'PLICATION FOR SANITATION PER' T y &'73 � Permit No. .7.._-....... (Complete in Triplicate) ... ... ........................................... This Permit Expires 1 Year From Date Issued Date Issued 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 C n O 'na ce o 549 and existing Rules and Regulations: � �� /W JOB ADDRESS/LOCATION 4C-/�S; SJL)sr.Q - ir-�QN.....R.D...........................................CENSUS TRACT .-....................... Owner's Name .....TR4125..I=I IO ..S]de: ...................................Phoned..=a/�a.........--- _ Address -5,4W-------------------------------------------------------- .................__----........ city ......................................... --....._............_--............... Contractor's Name ,/..�E .-S /F' / ....4A-6V......................License #Aj_ -.3...... PhonelW. :!-5.224C... Installation will serve: Residence Apartment House❑ Commercial Wraller Court 0 Mote[ ❑Other ............................................ Number of living units:...0...... Number of bedrooms -0.......Garbage Grinder X14?.... Lot Size ...._._.._.. Water Supply: Public System and name ...... ..............-- ...................... ...........................................................Private Eff Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ r, Hardpan ❑ Adobe W Fill Material __.--------- If yes,type ............................ "V (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,) PACKAGE TREATMENT [ ] SEPTIC TANKSiae.g 3.. .......................... Liquid Depth /.................. Capacity I;X.......... Type/0r.. MateriofLj` No. Compartments 4.;?................ Distance to nearesh Well ._�r1Q................. ) ..........Foundation .&................... Prop. Line a ............. LEACHING LINE. ()Q No. of Lines ...o/S ................ Length of each line....$0---- ............. Total Length A& - ............. 'D' Box #$._ Type Filter Material teOLK--.-...-Depth Filter Materia[ --../,0-1 .............................. - Distance to nearest: Well ./0.. -- ...... Foundation ........ Property Line �...............: SEEPAGE PIT [ j Depth .................... Diameter ................ Number ............................ Rock Filled Yes ❑ No Q Water Table Depth ..........................--...........---.....Rock Size .. ..................... Distonce.to nearest: Well ........................................Foundation ...--............... Prop. Line ..................._. REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date ......................._......... ) SepticTank (Specify Requirements) ....................................................................................................................................... Disposal Field (Specify Requirements)' --...................................-...............__................... ............................ _...... ................................................................ ......................................................... ..................................-........................ ----------- ...............................-......------•----•................................... .....-............. ................................................. ----- .............. (Draw existing and required addition on reverse side) 1 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 lican- 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 parson In such manner as to become subject to Workman's Compensation laws of California." Signed ....--------- ----- -- .... Owenr By ...._ ..........------ titl .. � ✓ ... (If other th wn F DEPARTME T USE ONLY APPLICATION ACCEPTED BY ... ... _. ..... .. -- ------------- - --- . ............. ..... .... DATE .... .... 7.'Z - BUILDING PERMIT ISSUED ......................................_:.. ------ . ......... .....................DATE ........----........... ................ ADDITIONALCOMMENTS ................. ................................__................ ---------.................... ................................ .......... .................................. ........ ....................................... ............. . .......................... ................................. ................ ----- ------...................... - ........ - ------------------ - •-----------------....------------------...---------------...-------------------------------. - Final Ins ection b . //77 Py� -------- . .. ... ... ....... ........_ .........................................-.............-.Date ... -�•J -- --...---- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 13 24 1-'68 Rev. 5M -i 7/72 3 M