SU0000060 SSNL - Laserfiche WebLink

Home Browse Search

i FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. ZL.:...`�!.y.... Date Issued --.4..7:..7..2, , This Permit Expires 1 Year From Date Issued Applicotion is hereby made to the San Joaquin Local Health District for a permit to construct and instoll the work herein j described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: G I' JOB ADDP.ESS/LOCATION ��]/-..J.I L-� :J. -. CENSUS TRACT .......................... Owner's Name - r Z. � ....... ..... ..... .......Phone c)... ............... Address 75 C / C ...... ............ city/11/7/ r .........................`. .c. ......... Contractor's Name C �= : C /i/< %/`c= _ _.. .. .. . _ .License 4/ ��Ey. Phone J. 2 ...6 u Ins•allation will serve: Residence Q Apartment House❑ Commercial []Trailer Court ❑ Motel ❑Other . ........ ..... ........ Number of living units: ^z �� 7f ........................ Water Supply: Public System and name ....... ..... ..... . ............._.. ... ............. .............................................. --Private L Character of soil to a depth of 3 feet: Sand CR Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material If yes,type .................. ......... (Plot plan, shoving 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 [ ] Size ......._.......... ... .. ___. Liquid Depth .......................... Capacity Type .. . ... ... Mater''I /- No. Compartments ...................... Distance to nearest: 'Nell ......Foundation .... .. ............ Prop. line ...................... LEACHING LINE r ] No. of Lines Length of a line . . . . _._ Total Length ............................ 'D' Box . _ Type Filler Material .... ..............Depth Iter Material .... ....................................... I Distance to nearest: Well .. .. ... Foundation _.. __ .. Property Line ........................No SEEPAGE PIT [ j Depth . . Diameter . ..... ........ Numbe• _ Rock Filled Yes ❑ ❑ Water Table Depth _. - ........ ........................R _k Size .._. .......................... Distonre to nearest: Well .. .. ......................... .oundation Prop. Line ...............I...... REPAIR/ADDITION(Prev. Sanitation Permi' # _. _ . ate . .. . . ........................) Septic Tank (Specify Requirements) ..... __..... ... _ .... ._.... ........ ................ ...I.....I................................ Disposal Field (Specify Requirements) ....... - - - - .... �- _. . (Draw existing and required L 'ition on reverse side) I hereby certify that 1 have prepared this application and that a work will be done in accordance with San Joaquin County Ordinances, State Laws, and Pules 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 . .e work for whicS this permit is issued, I shall not employ any rerson in such manner as to become subjecttttteo Work p's Compensation laws of California." Sicned �/ / _... . .-.... Owner ,y /e-X /e Title _ If other than owner) / FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY N/ = DATE RL':LDING PERMIT ISSUED DAiE ... .'.DDITIONAL COMMENTS � ...�.:,-,...� :-•' _�- ._• - ,i`�. . Final Inspection by: Dara��' -•4 SArJ _!CA ;UIr: LC! ;L HEALTH DISTPICT H 9 1-'68 Rev. 51,x,