SU0011452 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT f�$b Permit No.�y' (Complete in Triplicate) -............. ......................................................... - ......••••-•..... ............................. ......... This Permit Expires I Year From Date Issued Date Issued.,l.?..4.:;1T 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: z,. . JOB ADDRESS/L TION... ._. . � �Jj NGS. .:...... .........................:.................:•.---..CENSUS TRACT.p.;..�......:_...........// Owner's Name... N.> t,,.D....... . .Q....:......................................... .. :......_... ...... .Phone 4L14?I... .. ..... rr C ' k / Address... �. y. i�. ......., . .. �.Ir:_�.�...,..,...._............._'..*...............,City..a..l. .4.t..��?.Zip...:... .�C�>/��o Contractor's Name............ ....._.... .......License #........:...................Phone . .Lg. .. Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel " ❑ Other................................. . . Number of living units:.......f.,......Number o edro S.._.I .....Garbage Grinder.. . ....Lot Size...........T........................::.................. . w Water Supply: Public System and name!..... � ........................ Private ....... ................................... ............_. _ Character of soil to a depth of 3 feet: . Sand.W Silt❑. Clay ❑ .Peat❑ . Sandy Loam Q 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 [ J Size...........................................................Liquid Depth..:::...,...............( . Capacity.....................Type.......................Material... ......................No: Compartments......:.:...,.................. c Distance to nearest: Well...........................................Foundation....... .. . .............Prop. Line.......................... LEACHING LINE [ 1 No. of Lines. .................... .Length of each line..............................Tota[ Length ........................ ....( 'D' Box............Type Filter Materia[...............:....Depth Filter Material............................................................ Distance to nearest: Wel[............................Foundation._....._.._...._...___- ....Property Line.................................. SEEPAGE PIT ' [ J Depth................Diameter....................Number. ... Rock Filled Yes ❑ No C Water Table Depth................................................. •.. .Rock Size-- • .I..........................E............ Distance to nearest: Well............................................Foundation..........................Prop. Line........................... REPAIR/ADDITION (Prev. Sanitation Permit#.................... ............Date........:.....................................) Septic Tank (Specify Requirements)..................,..........:.................. .J........../...-...f f /� ....... ( ................. Disposal Field (S ecify R/+equirements).......i.".1.^,xj1-t."Ltef.....44:ei//.......ralla:i�/J`t::...1!l rR-----1-h�r.I¢�!/�c .........Jlsif.d..................... 7 ........GOa.;t!.C!'........ R-----------S G.ncY....... .4/"L .( ........ .. ........ ..............1.................. •-----•........... (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 Counh Ordinances, State Laws, and Rules and Regulations of the San Joaquin local Health District. Home.,owner or licensed agent: signature certifies the following: "I certify tho n the p rfo a ce of the work for which this permit is issued, 1 shall not employ any person in such manner at to become su r s Compensation laws of California." ..__Owner ,: s By.........................................................................................................Title.. ...... - ........... . . .... (If other than owner) FOR EPA MENT USE NL APPLICATION ACCEPTED BY............... .. - - .......DATE .......� ._ - ................ DIVISION OF LAND NUMBER....................................... .......DATE........_...... __ ................ . ................... ADDITIONAL COMMENTS............................... ......... ..... ........ ...... ------ ...................... . ..................................... y - - ......'............. """""-..........�.�.. c,C�..r,mq..G,:,r�-... . . � ',:f#....:.GG ------------ ... -.................... .............-- ..........---.................. .... .............................._.......................................-.............................................--------- ........................ ................................................. ...................... Fina[ Inspeti:on b ..Dote.................................................