SU0005755 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: I APPLICATION FOR SANITATION PERT I ... ............... (Complete in Triplicate) Permit No. -, 7 7-.Z r .................... ThPermit ermit Expires 1 Year Front Date issued ............ . Date Issued ...,f�X -.77 Application is hereby made to the San Joaquin Local Health District for a described. This application is made In compliance wit ounty Ordinance No. 54rmit 9 and existing Rules construct and tand Regulations.rein JOB ADDRESS/LOCATION , ...... Sr9 7 Owner's Name . ....... - -• .• .�.CENSUS TRACT. •_- Address --- . ... ............ ...... .............F . ._. qty . UPI. .. . ....... Contractor's Nome .G,... , 1t ._..... ' !'v: ...................License # Vic?-8' . Phone . . Installation will serve: Residence[]Apartment House 0 Commercial❑Trailer Court ❑ a Motel El Other.............................. Number of livingunits:..- Number of bedrooms ..!_.....Garbage Grinder .. -p Lot Size �r Water Supply; Public System and name 5....--••• ..__----------••..._............ Private (� Character of soil to a depth of 3 feet: Sand . Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan[] Adobe ❑ Fill Material ...--._ ... Ifyes,type................•-------- (Plot plan, showing size of lot, location of system in relation to..wells, j buildings, etc, must be placed on reverse NEW INSTALLATION: (No septic tank or seepaside.[ ge,pit permitted if publicsewer is mailable within 200 feet,j PACKAGE TREATMENT [ ] SEPTIC TANK ] Size.. 2I 9 _. _.....-w Ligt�d Depth . Capacity ._SOC....... Type �1ti.r Material.. 1�_w� - No. Compartments Distance to nearest. Well p .. - - - ••--.[fly ..Foundation �C.�.._•_-_- Prop. Line LEACHING LINE [ ] No. of lines 1 i ~ Length of each Ione---.--- �........ �— ••-•----...:._. ...... Total Length 'D' Bax / Type Filter Material -Depth h Filter Material ... -- Distance to nearest: Well Foundation ---••-=-----•----- Property --=-----•---••--••-----• Line SEEPAi''.�E,P�T` [ ] ...............Depth .................... D€ameter ' � Number ... Rock Filled Yes ❑ No ` - Water Table Depth ...............................Rock Size Distance to nearest: Well.................. ...Foundation REPAIR/ADDITION{Prev. Sanitotion'Permit Line ...................... .... ".." ....._.,.... ................._ Date Septic Tank (Specify Requirements] . ............... ..... --•................... Disposal Field (Specify Requirementsl ---AC._&/1�1gy --------- --•------- --•--- ----••--- , I' ....................................... ..................__....:.._. - ..... . . ................. I� (Draw existing and required addition an 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. Nome 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 as to become subject,to Workman's Compensation laws of California.,, Signed .....- . ay ....� .........Owner . Jitle ---- .......-. _-. .. (If other than owner) ..-•......................... ... FO EPART NT USE ONLY } APPLICATION ACCEPTED BY .. ' BUILDING PERMIT ISSUED ------- -- ------ DATE .1.:.-. ...r .�._._....---•- ADDITIONAL DATE COMMENTS ..• --•... ....... •-•- -------- ......... .......... --••--.. - -------------------•--•----••••-•---•.....----••--.----•- ... ..... Final Inspection by �N -•--- ............... ...... ---- ... -- ••- ---•• .............. .........Date — ... _ _........................ 7 JOAQUIN LOCAL 14EAALTH DISTRICT E. H.13 .24 t_'68 Rev- SM M �i-V., e ..