SU0011006 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: _ .. APPLICATION FOR SANITATION PERMIT --------- - ------- --------- Permit No. (Complete in-triplicate) - .............------------ ------- ----------- ...........................: This Permit Expires 1 Year From Date Issued Date Issued .. as . rt 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 co_m. lp.li.aa..n_.c.e/�.wr�.it=hCounty Ordina ountyOrdiinance No.]5499--and existing Rules and Regulations:lations: JOB ADDRESS/LOCATION -- - --CENSUST ACT --- -............... ..... Owners Name IF .,1V _..................... . ...- one ------------------------ Address - Address .--- ------I ----------------- C h -- --- ----------- ---- ----- -- .........-........ =,.: Contractor's Nome ..... ............ . _ -14cense Phone .............................. Installation will serve: Residence [Apartment Houser].Commercial_(]Trailer_Court i[] (] ------------ Motel Other -- -- _-1------------------------------I —�_ Number of living units: ------ .--. Number of bedrooms .1. ----Garbage Grinder ..._......_. Lot Size ..._._. _ ------ _.. _---- Water Supply: Public System and name ..........--''-.-;-.'/-- `✓`-.---.-----------,._`- ---------------------------------------------Private [?� ✓ --' , " . Character of soil to a depth of 3 feet: Sand's Silt❑ r CIa _7P6dt0- ,Sandy Loam C] Clay Loam [] Hardpan r AdobieJ Fill Material ...... If yes;type .'----------------- .. ---_. i (plot plan, showing size of lot, location of system in rielation to wells, buildings, etc. must be placed on reverse side.( , NEW INSTALLATION: (No septic tank or see ge! pit permitted if,public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK'[ Size- /Y.�p �/� ✓� -- _ Liquid Depth Capacity/ Wee", - TypeMaterial /_y . -. No. Compartments Aa-1 ............. / l"r«". - Distance to ne Well ........_?G-� .. ...._......Foundation ----./0------------- Prop. line -... ........-...- LEACHING LINE [ No. of Lines __ --------_.._ Length of each line-------7.17__-.-....__ Total Length .,;.24e..�......... 'D' BoxX0__ _ SO"— Filter Material __S'2_r-----Depth Filter Material __./!'._._------.___.._.............. Distancenearest: Well ----- O"-,------- Foundation ------- i--------- Property Line f............ SEEPAGE PIT [ J Depth _ Diameter ................ Number --------------------- Rock Filled Yes C] No i0 Water_Table.Depth.............. ----------......................Rock.Size ....................... ........ - Distance to nearest: Well ........................................Foundation ...----------------- Prop. Line ...__._.__._._.,.--_. REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date ........................----------) Septic 7 nk (Specify Requirements) --..:--- -} �`r -- '`- _ r .-J4.1..!..................... .... . ....- •---- ----------- --- S1 nDisposdl� (Spedfy'Requirements) ..........................................--------------------------------------------------- ---------------------------------`----- _�� (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 Son 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 o orkman's Camp &nsation laws of California:" ejf Signed .------- -------- -- - Owner • By ....... -- ....- - -------------------/,itie . ...................................... (If other than owner) FOR DEPARTMENT USE ONLY APPLIC TION ACCEPTED BY -- --- --- - --------- --------- ------- -------------------- -..............-_. bbTE - - 0--<pQ .................. BUILDIPERMIT ISSUED --------- - - ------- - ---------- - -...... .................---------------- DATE ................................... ADDITI AL COMMENTS -- - -------- ------------------- / - - - - - - - - ------- -- --- ---- ----------------------------------------------------..-..- --- ---- -- -- - -- ---------•----- ------------- ---.--. - - -------------------------- ---------- 4 ......................... .. ... .. .. ... .. .. .. -.-- _ _____. Final lns ection b . P Y. - ----------- --------- - - Date ..�� - --`--------------- SAN JOAQUIN LOCAL HEALTH DISTRICT