SU0004662 SSNL - Laserfiche WebLink

Home Browse Search

A►rrL1%.A11VIN t-VK �AINITATION PERS 'T -._... - Permit No. ._��'.-�S (Complete in Triplicate) -------- ------ ..-_._____ This Permit Expires 1 Year From Date Issued Date Issued ._1-`6-�76 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/LOCAL' N CENSUS TRACT ----- Owner's Name - /-1-._� J....._._, ...._.. ........ ---- Phone Address City f -. .�.�......_ r.. .... ILI f Contractor's Name ..... --- _.License # .Y .Q..y Phone .... .. ..... ....... . Installation will serve: Residence [�Kpartment House C] Commercial ❑Trailer Court ❑ Motel ❑Other . ......... - ------ Number of living units: --- Number of bedrooms T-----Garbage Grinder . _... Lot Size Water Supply: Public System and name --------- -- ----- -----------•-------_------- ---...------------------------ --- --f-- ----- ------ ......Private Character of soil to a depth of 3 feet: Sand E] Silt EJ Clay El Peat E] Sandy Loam U Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material _ --------- If yes, type ............... . (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 TANK I ] Size------------------_----------------------------- Liquid Depth ... ....................... Capacity -_ _ ---- --- Type ----_------- ------- Material......_._.-. -------- No. Compartments O Distance to nearest: Wel( __.__._._.. .------------.-----Foundation _...._._.. Prop. Line ......................N LEACHING LINE [ j No. of Lines . . ---------- ._._ Length of each line___..__ _ _ _ - - .... Total Length ---- ----------- --------- 'D' Box __._ _ .. Type Filter Material .._-_-.-_.-__-.._Depth Filter Material _ --- ----...._. _.--_................� Distance to nearest: Well ----___- ----- ------ Foundation _ .___ Property Line - -----_-------.._-.-__ l SEEPAGE PIT ( j 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 ---------------------------------- SepticTank (Specify Requirements) -- - - --------- ----- --------------------------------------------------------------- ------------ ----------------------------- + C t1----- isposal Field (Specify Requirements) �.� s_ i>ty. ..�Cc:s- _ :: - .. - ------ ------- _ (Draw existing and required addition on 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. 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 ._ ---- 1 - ------. Owner BY - - --- -------- - -- -- - -....._ Title '-` '.v11 _ - . . ... (If other than owner) FOR Q ARTMENT USE ONLY APPLICATION ACCEPTED BY _ _. _.____ DATE _ J"I4.. .�4--_ ------ BUILDING -------•---- ------------ _- -- - BUILDING PERMIT ISSUED .... -- - --------------------------------------------------•------- -------------- ------ -------DATE _ ADDITIONAL COMMENTS .--- ---- ---------- ------- --------------------------------------- -------------------------------------------------------- -_--------_--_--------- ----------------------- -- -- ------------------------- -------- ------- --------.....----- ----------- -- ......... ----------------------------------------------- ------- - -----------------------•-------------------- ------- - --------- --------------------- ---------- ......... ------ ............. --------------------------------------- ------------ Final Inspection by: .................. ��..--- ------------ ---- -------- - Date .. —I' :�. _ ..-.--.- - SH 13 2L 1-68 Rev. 5M SAI`! JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M d