SU0012713 - Laserfiche WebLink

Home Browse Search

"01% v'"y4 "%"' APPLICATION FOk SANITATION PERMIT ..................I •--•-•••... Permit No.77` :... � (Complete In Triplicate) ................... l Date Issued .-a ..rl. ....................................................... This Permit Expires,11 Year From Date Issued Application is hereby made to the San Joaquin Local Health',IDistrict 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 .....�. .7!S`�... ..... -- .------ `� ........ CENSUS TRACT --------_-__-------- Owner's ...............Owner's Name ........... .4Aq? .:..... ...... '' .......................:....: ..............Phone `. -=/_ d.......... Address .... ''// II City .................. ............................. Contractor's Name --- ...........................��........ ........License # .........-.............. Phone .............................. Installation will serve: Residence❑Apartment House❑ Commercial❑Trailert'SIr 4 Motel ❑Other............................................. Number of living units:..3------- Number of bedrooms s3....tGarbage Grinder ............ Lot Size i� ...................................••••................— iv \ Water Supply: Public System and name ................................. . Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam 0 C Hardpan❑ Adobe FlII Material ............ If yes,type............... ............ (Plot plan, showing size of lot, location of system In rela Lon 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 ( t SEPTIC.TANICj Size`r.�V...... ..._ :~..yliquid Depth y='---r--- =-y- I� a Ca ci / �a T . Material...C✓i*,t..... No. Compartments .. ........._._ Distance to-nearest: Well _.f..d o..'...' ................Foundation Z?...::........ Prop. Line ..!71--i........... LEACHING LINE ,A-) No. of Lines ..1------------------ Length of each line........ -0............. Total Length ...?9...............IN 'D' Box . ._... Type Filter Material,"..i........Depth Filter Material ./Y................................ .. Distance to nearest: Well ./.!!O'_.:i�_.......foundation .....0..:_•_x.-........ Property Line ...r'.!................ Depth .?�a............. Defer -/_x'.1.2. Number ._... _/................ Rock Filled Yes-P No (3Water Table Depth ...�!t •--•---�.......................Rock Size •-.r:'T.�.................. Distance to nearest: Well .1..,?d..:'! ..._. .......foundation ....... Prop. Line ............. REPAIR/ADDITION(Prev. Sanitation Permit# _......................:�..._.........._.... Date ..................................I Septic Tank (5pecify Requirements) DisposalField (Specify Requirements) ............................ ... .... ......I.......__.....-------•--•-... ................................. ...........I....... .................................. ......... ....................................................I -•----. --•-----...................................-- ......---•--. ........................................ ........... ......-----............... (Draw existing and requir ed addition on reverse side) I hereby certify that 1 have prepared this application and the work will be done in accordance with San Joaquin Cou ty Ordinances, State Laws, and Rules and Regulations.of the San Joaquin Local Health:District. Home owner or licen- sed o ents signature certifies the following: "t c\ that in the perKrkman's .of the work for which this permit is issued, 1 shall not employ any person In such manner as to come sub)oci to Compensation laws of California." Signe O�"� ------------------ -.--------------------I-----•---- Owner By ---------- --------- ------_-------- -- ........ ....-----•. l�..•---- .. Jule .................................. --- ... ...........-... .. ----•• (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _. ....... DATE 4-":2- -•:� �.-•--••-- ----- ... 1...........:• ..DATE - I BUILDINGPERMIT ISSUED ...................................... ............................................................. ......................_._............ ADDITIONALCOMMENTS ................... ........................_--....... ............................................................................._............:............. ....................................... .. __..................... ......... _.. ...... ..._... ......... ............................................... ...... . ... ....... ............... .•--• -----•. ....---...------••-------- ...._.........._...................---................_.._. ................................... A.. . ....... ................. ....... Final Inspection by: . . ! Date .'!' '�' EH 13 24 1-68 Rev. 5m SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3M