SR0080749_SSNL - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT .............................................. �I� (Complete In Trlpticate) Permit No. ..5.�.:Y}................................................... This Permit Explras 1 Year Front Date tssuee!! _..~ Date Issued d=;x:;22 - uW Application is hereby evade 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/L Owner's Name r ,-�f �2 ,`,E ....................... ...........................CENSUS TRA..... ?hone CT .......„... Address Contractor's Name..................... .................................. city'.... ..�G ..................................................... L -..x' ...................................._...........License+�� ¢Q !... Phone ,fYX.-.�.P6._.. Installation wit! serve: I Residence U-Aipartment House] Commercial❑Trailer Court 0 Motet❑Other............................................ Number of living units:.. . ..._ Number of bedroorns red-_ _ -'�`1 _Garbage Grinder, .......... lot Sine Water Supply., Public System and name j........................ ........ _...... ........................._.................. Chander of salt to a depthof 3 feet Sand 0 Silt[� tayr []..Peat�]. .Seyndy Loam t]- Clay !gyPrivate Hardpan 0 Adobe Q FI It Material............If yes.type............... .._........ !Plot pian, showing size of lot, location of system hi rotation to wells, buildings, etc. must be placed on reverse side.! NEW INSTALLATION: (No septic tonic or seepage pit permitted if public sewer Is available within 240 feet,t ' PACKAGE TREATMENT { }, SEPTIC TANK 1 Size......................... ...................... . = Uge11d Depth ....... ............. Capacity .................... Type ........ Materlal. No. Compartments Distance to nearests Well' .Foundation _.. . Prop. Line. No'! / , LEACHING LINE { j i�loi; of Lines l.. ....-------,..-e.l,eng th..of aadt line.....�F.............. ?'ata! length ��.._......._..ar D. —777.-Type Filter Material ._... . Depth fitter Material �...............:........ ....... Distance to nearest, Well .........................Foundation .t...._:................ Property line ............:........� i� S EPAGE PIT C I Depth ..........---. Diameter _ �-”; N -H be��. .._; .. ........... Rock Filled Yes ❑ No� Water Table Depth ...................... Size............ .,.. --..... . Diatartoe to nearest: Well ............._ __.._»Foundation .......... Prop. kine .: REPAIR/ADDITION(Prev. Sanitation Permit#........................ '.._._^!...... .... Dote ... { Septic Tank (Specify RequirementsM ............... ......... ........ ... .....-.....----------------------------------,.... ....... i Disposal Field (Specify 'tiequirements) ...r _............................. .....:.......��, .. ........ ---...._ _ •--..........: ........ ..........` ......_. .................................................................. ............................ existing enc!required addition on reverse side! .. f --- - .............. i I Hereby certify that I have.prepared this appllZ fllon and that the work will be clone In a=mMnco with San Joaquin ` County Ordinances, State Lbws, and Mules and Regtrlailons of the San Joaquin Local Health District. !lame owner or Baer• sed agents signature certifies the following: "I certify that in the performance of the warik for which this permit Is Issued, I shall not employ any person In'such manner as to become subject to WoOkman's Compensation laws of California" Signed _.[ .... --._...... Owner By .................... a .................. .......................... .. Title (If other than owner( Ii EO DEPAtITII EN USE ONLY APPLICATION ACCEPTED $Y..... DATEt'� .....BUILDING PERMIT ISSUED.'! AQ(31Ti0 L CO ENT5 ... :......... ,. .-,..D TE :. ---------- f ............:...:- ----------------........... �....... ......................................................_. .... ........ .......... ................................... . final Inspection by: . .................... .............• ........._... ...Date.... .... ..........._.. ,.... ....... . ESI 13 2!t �.. �!` ?.................. SAN JDAQUIN !f)CAl HEALTH DISTRICT' 8/74 3H �