SU0012627 (2) - Laserfiche WebLink

Home Browse Search

' FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ....................... (Complete in Triplicate) Permit No. .......................... This Permit Expires 1 Year From Date Issued Date Issued 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/LOCATION . 1101.3.......x:.. __� �yl.�/ "' ........CENSUS TRACT .......................... Owner's Name .......Phone v�-�3iJ....... Address ...... ....._.� . F.. ........ ..... .......... City ........ .. . .... ........ f-........--••-------........ . ............... Contractor's Name .....................C. .. ---.--.License #9?�Y_5...... Phone Installation will serve: Residence❑Apartment House 0 Commercial OTrailer Court [D Motel❑Other ............................................ (Number of living units:......l.._:�•Number of bedrooms _._.5. ..Garbage Grinder ............ Lot Size ......... ................. .� titer Supply: Public System and name Ck� ....................Private �V, PP Y Y �...� ...................�........._.............. + L. Chard6er of-soil-to a.depth of:3• eats Sand 0,`Slit❑ - Clay [3. _Peat:❑ Sandy Loorn Q-.--Clay-Loam-E] � t Hardpan p Adobe fill Material ............ If yes,type ............................ `L - (Plot plan, showing size of lot, location of system In relation to wells, buildings, etc. must be placed on reverse side.) fj NEW INSTALLATION: (No septic tank-or seepage pit permitted!!,if public sewer'iiavailable within 200 feet,) PACKAGE TREATMENT ( ) SEPTIC TANOK � -Site..................x_�$_ _..:..:._..__._.... Liquid Depth .... { Capacity :��. Type .. .. \.-- iM�terlal... -----�-c�.--- iJo. Compartments ._...z-....... _ 0 t Distance to nearest: Well ...... ��_ `..*'_Foundation.. .....0 "r... Prop. line ... �.�'....... W LEAGFA1 G-UNE -�-K=Vq.'-of"tines�....: !? .. Length of eat` e.->....`,t �. .......... Total Length k0 4P �'D' Box .. ...... �ilte Material .......... ... Depth Filter Material --•---- s�............................. .[ Distance to nearest: Well .. :."t.... Foundation ...:� ................ Prope Lltte rty EPAGE PIT, Depth�4�`•. r_. DiameterNumberI _f. ��Rock�FilledYess�� No\4, E NWater Table Depth .... .: . _._- ........R, Size i1`}n�.�x._. Y - Distance tb'rteorest: Well :..__:f. ............. ...............Foundation ....... ..... `_: Prop. Line ....15__........... REPAIR/ADDITION(PrevrSanitationPermit#- .... Date ...... ..../ ............ ) t if Septic Tank (Specify Requireni ten s) ............._.. ...._..--M _• .::.. = .�„�...................... Disposal Field (Specif Requirements) -7G i3i.._... r K.- - '� .... :. .. .... . (C row existing�d regdired addltlon on reverse side) �� t hereby itifj that 1 have prepared this applications an`d that the work willibe done In accordance with-San Joaquin County,,Otdinartces, State Laws, and Rules and Regulations of the Son Joaquin Local.HealthiDlstrlct. Harm owner or licen- sed agents'tignature certifies the following: , "I certify that in the performance of the(vork for which this permit�isI sued, 1 shall not em�lo 4y penort'In such manner as to become subject to Workman's.Compensation laws of_Caiifornia." Signed ---------------- -_... . ... . ! - ............. Owner By................... .. Title ... I {?rr �. ( f other th owner FOR DEPARTMENT USE ONLY +� APPLICATION ACCEPTED BY . - . . . ........ ... .. ...................................•------ 3........1..'.7......................DATE .... . BUILDING PERMIT ISSUED . --------------DATE ........................................... I ADDITIO AL COMMENTS .>.. . f . . .. .. .; _._.... _................ ........................... ....................................... . -----• , I Final Inspection by. .... :.................................................Date f/..:1 .: SAN JOAQUIN LOCAL HEALTH DISTRICT E_M 13 24 ,.-AarL_ --