SU0007284 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: e PLICATION FOR SANITATION------- PER, I ,... ......:....:..... - (Complete in Triplicate) Permit No. . ..~.- 3 Date issued J..�.A._ ............-•.-„................................... This Permit Expires t Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a per to construct and install, the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: J48 ADDRESS/LOCATION ..r f _ ._..._. 1. .............. c --.....................CENSUS TRACT ...... ............ •.. Owner,..... ..... . _. .. . .. ..,_.._x..;.._-. . • s Name .. _ ._�_S:. r_....._._.. . �-U � Phone . City aAddress _.... 3---... .....-- ..._._... r Contractor's Name _. ... ......:...................:.............License # -...-._.. .............. Phone . _ _�.� .. Ing,tollation will serve: Residence Apartment House Commercial ❑Trailer Court 0 Motel ❑Other_...----•--• -----.. -•--------------•--- >� Garbo e Grinder . Lot Size _::.Lr9 -Q• Number of living units—.5---- .of bedrooms .. ---_--• g ---- --' -------------= Water Supply: Public System and name ---..................:...................................._._..._......................_..........................Private, Charocter of soil to a depth of 3:feet: Sand.'❑ Silt❑ -Clay .0 Peat❑ Sandy loam N #Clay Loam 0 Hardpan C]❑ Adobe :❑• Fill Material ............ If yes,type __-_ ..................... (Plot pian, showing size of lot, location of. system :In relation to wells, buildings, etc, must be placed on reverse 'slde.1 NEW INSTALLATION: (No, septic tonk.or seepage pit permitted.if publfc sewer is available within 200 feet,} PACKAGE TREATMENT : [ ] SEPTIC TANK I Size-----------------------------------•............. Liquid Depth _••---.:-.-__---- Capacity ................. Type -------------I----.. Material---------------------- No. Compartments Distance to nearest: Well .....................................Foundation .:.................... Prop. Line LEACHING LINE No.-of Lines ....................... Length of each line.----.-.------ .......:..... total Length ............................. N ype Filter Material .. ....Depth Filter Material ..:.,....... ...: Distance to neo st.'Well. ...._ Foundation .... .:x Property Line SEEPAGE PIT [ ] Depth _ ................. Diameter . Number --- .--...._...._..:... 'Rock Filled -Yes.-d No Water Table Depth .............-----••------••--•---..--•-----•--Rock Size .................................. Distance to nearest.• Wel) Foundation ..................:. Prop. Line .........r--_-------- REPAIR/ADDITION(Prev" Sanitation Permit 91E :__ Data ) ........ -- -------------•-••. . •... '1 Septic Tank (Specify Requirements) -----------------:- : �- Disposal Field (Specify Requirements) .....-� + _. r• - ---- ......... ------------------------------------------- ---- t --------•---- ..._...--- •-------- -•------ -••---------- -•-----•---------------------------------------- --- ---- (Draw existing and required addition on reverse side) I hereby certify that l have prepared this application and that the work will he done in accordance with'San: Joaquin' County Ordinances,' State Laws,.and Rules and Regulations of the San Joaquin Local health District. Home owner'or licett " agents signature certifies the.following: "l 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 ---- ----------------- = :.:..._....... Owner B �... -----.. .Title ..: ' - --- -- ---•- if other than owner) f2!,1@PARTMENT USE ONLY APPLICATION ACCEPTED BY . :... DATE.. ��.�.�..:..�............. --- i3UILDING PERMIT ISSUED . ............... .........._...__ ....... :......:........ DATE ADDITIONAL COMMENTS ...---•---•-----.---•------- -------- •---------------------------------------------••---------•--- . . . ---•-•...-••-----••- •--------•---•---• -----•------- --• ---..:---------------------------------- . --•- --•--- ............... -.............................. ...... .. Final lnspection.by:;_..: .............................................................Date ... ....1l- , ... .,.... ._,_ w. e..._r...n .SAN..JOAQUiN LOCAL HEALTH DISTRICT T `'4 F LJ 3 1-,Ao o.... aril/ 7 177 1V