SU0005084 SSNL - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. . _...---..7.7.... .... . ...... ... . This Permit Expires 1 Year From Date Issued Date Issued ....'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 is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION /.755/ l _.. - ..jc' _. CENSUS TRACT ------------------ ------- Owner's Name -..... - = ..... . .. --------- ........ ....Phone .................................... Address ---. city _.. ----- ------ - ----•--•------------.. Contractor's Name . ... - License # /fid` 317 . Phone ....... . ---- ----- ........ Installation will serve: Residence (Apartment House-[:] Commercial ❑Trailer Court 0 Motel ❑Other Number of living units: �. Number of bedrooms . 5...Garbage Grinder lot Size . _ _...._. _........................ Water Supply: Public System and name . ------- . _ _.. .......... ------------ ---Private Character of soil to a depth of 3 feet: Sand n Silt❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ( Adobe ❑ Fill Material ._ If yes, type . (Plot plan, showing size of lot, location of system in rela_tign 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 TANK[ ] Size_.. _-------------- __ Liquid Depth . Capacity . . Type _ . ... .. .. Material..._ No. Compartments ---------------------- Distance to nearest: Well _..----.-._Foundation . _ . _--- Prop. Line ---- _. _---__.---- LEACHING LINE ( ] No. of Lines . Length of each line _ _ Total Length . .. .-.._ J 'D' Box Type Filter Material - ----_---_ ._-----Depth Filter Material . _ ... ... -- ------------------- \J1 Distance to nearest: Well -_ Property line------ Foundation _... . . . -- - - ---•--- - N SEEPAGE PIT [ ] Depth _ . Diameter _----------- -- Number __ _ _. Rock Filled Yes ❑ No i❑ Water Table Depth ... ._ .-- --- --- ------- ----------- ----Rock Size .........._ - ----------------- Distance -- ---------...Distance to nearest: Well _ . __..... .---- ._....__-.----Foundation . .... _. Prop. Line _-__............. , REPAIR/ADDITION(Prev. Sanitation Permit# .... _.. _ _.- ------ Date -----.............................) Septic Tank (Specify Requirements) -------------- . .............._.... .. ....... . _..... ....._--- -- ...._..... Disposal Field (Specify Requirements) ..��-_ ...- f� (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 Joaquip_( 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 as to become subject to Workman's Compensation laws of California." Signed . _ _ --- ----- ------ -- --- Owner By ... .. Title (If other than owner) FOR DEPARTMENT USE ONLY -- APPLICATION ACCEPTED BY er",/01 DATE BUILDING PERMIT ISSUED./ DATE __ ... ADDITIONAL COMMENTS�IZ®�a. ew_- _ _- _. .. _ _. -- - -- -_... .. ---• ._ .. .... .. . .. Final Inspection by: - �. . _.. .Date / 7 -- ------------ SAN --- - SAN JOAQUIN LOCAL HEALTH DISTRICT ,— , 13 24, 4�,n O