SU0004747 SSCRPT - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT n V/ -� Permit No. _.�...7--"17 � (Complete in Triplicate) `� )/� [� —6Date Issued ---------- This Permit Expires 1 Year From Date Issued o 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 unty Ordinance No. 549 and existing Rules and Regulations: ��« � JOB ADDRESS/L 1 N ----- - _- s-- - ------ -------CENSUS TRACT --------.-........---j�/ Owner's Name - ---- � ------ -o- iYe o� J-------'• ---"-----------Phone =�---T--r.!1. Address ----------------�_ ------------ t House fl Commercial❑Trailer Court [] Motel ❑Other -- ----------_---------- ------------ - Number of living units:---- Number of bedrooms -21-----1 Garbag Grin er . ___.--.. Lot Size ..--___......... ......... ........----- Water Supply: Public System and name ...._..��.. -U.IGJad..Ce.� - -- �-1.----------•------------•-----•---- .Private ❑ r- Character of soil to a depth of 3 feet: Sand Cl Silt Clay ❑ Peat❑ Sandy Loom ❑ Clay Loom 0 Hardpan ❑ Adobe K 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 O SEPTIC TANK[ I 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 .-___.......-........._. 'D' Box ....__._. Type Filter Material --------__ -------Depth Filter Material ...._-------_______....._.,.,...�.. Distance to nearest: Well ------._.._._. .... Foundation _.._._._----- . ._._ Property Line ------------------- SEEPAGE _._--..--_-_-_SEEPAGE PIT [ ] Depth _....._..._.._._. Diameter __. ..... Number Rock Filled Yes ❑ No ❑ Water Table Depth -----------------------------------------------Rock Size ------------_-------_------ Distance --------------------------Distance to nearest:-Well ........................................Foundation_;_.--------- Prop. Line .................. REPAI ADDITIbN(Prev. Sanitation Permit# -------------------------------------------- Date`.:...... . ............... Septic Tank (Specify Requirements)- - - - ----- -----`--------- ---------------------------- posal field (Specify egvirements) JH i.IX JC/-G�Ldflat[:-- d-N el--.w __ _.___ pis Ll�o� �. t' 4 70 - - ------ --- --- ----------- - - ------------------ --------- ------------------------- — ----------- -_--------------------------- ----------------------------------- (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 alcordance with San Joaquin County Ordinances, State laws, and I)ules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the folioxring: "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 b come subject nt�Wo`rk on' Gompens laws of CCaa�ifornia." Signed� II�dL.I__liq > C0 By - - ---..... . ---------------------,� --- --A -- _....... - - -- (If other than ownerG ; FOR DEPARTMENT USE ONLY g APPLICATION ACCEPTED BY ----- - - -- ----- ---......--.....------- --------------- ---------- DATE ....._. -�y-G>. -- ---- BUILDING PERMIT ISSUED . .. . _._- -- -------- TE ` ADDITIONAL COMMENTS �9 �" d �Kv^�° ---------------ot ------------------ 1 �r r"Gl yi -- -- - - -'- F/,--- -------- -----------------------------------3 --�--- - ! ` I ------------------------------------- 1..... r � -'�- -- ----Final Inspection by: ----------- --- ------- --- --- --- ------ ----------------'------- - Date - SAN JOAQUIN LOCAL HEALTH DISTRICT d E. H. 9 1-'68 Rev. 5M