SU0000363 - Laserfiche WebLink

Home Browse Search

I FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete In Triplicate) Permit No. 7`�� • .. . 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 horein t described. This application is mode in compliance with County Ordinance No. 5I9 and existing Rules and Regulations► JOB ADDRESS/L TION 3� g �+�.-�. '� CENSUS TRACT _.._ ............. Owner's Nome ................... .......... . .. . .......... Phone . ..... .... ...................... Address .3.o fir d ..City r �,�-,.,. t�.... . ._............................... ' Contractor's Nome ' ^•-e:. ,�is hrf!..!ti!�.. ..license# . J09p.3 J>.—Phone .............................. Installation will serve: Residence eApartment House O Commercial❑Troller Court 0 Motel ❑Other F Number of living units. Number of bedrooms ...3.....Garbage Grinder lot Size .......... Water Supply: Public System and name . . ........ __ ............... . ....... ..... ............Private�r O Chorochr of soil too depth of 3 feet. Sand Df Silt❑ Clay ❑ Peat❑ Sandy loom ❑ Clay loam❑ Hardpan( Adobe ❑ Fill Mcterial .... .. If yes,type (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc, must be placed on reverse t►Me.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ) SEPTIC TANK O Size.... ................... _. Liquid Depth .......................... a Capacity Type Material...... No. Compartments Distance to nearest: Well _... .........Foundation ....... Prop. Line ................ x LEACHING LINE O No. of lines length of each line Total Length ..... ................... _. y 'D' Box . Type Filter Material ....................Depth Filter Material ... .. ............................»._.. Distance to nearest: Well .. .... .............. Foundation _......... . ... Property Line ...................»... SEEPAGE PIT [ ) Depth Diameter ................ Number Rock Filled Yes ❑ No Q Water Table Depth .. ... ....... .................................Rock Size ................................ Distance to nearest Well ...... .................................Foundation ..... ...... ....... Prop. Line ...................... RVAIR/ADWTION(Pray. Sanitation Permit# ........ ..... ..... ...... .............. Doh ..................................I Septic kTank (Specify Requirements) ......... ................................. ..... _ ................................. ............. s4 r Disposal Piold (SpecifyRequi t ......4I��. ��..�.+r*-W a ._.. .............. ................. 5a ��.-,- . ..., -�.�... .... -.-. ............! ..... . . •-�........... ..... .......... ... 3':.. ..�.5.. ............ ..... _ . .......... ........... ...... (Draw existing and required addition on reverse side) 1 hereby eotflfy that I have prepared this application and that the work will be done In accordance with Sen Joaquin Covedy OrdhMmos, State Laws, and Rules and Regulations of the San Joaquin Local health District.Mees owner or Ncen. eitl a@- is elgtnelaro certifies tho followingt y wl cerft IMM M the performance of the work for which this permit is Issued, I shell not employ any persen M such aesmser as to I soo i I eabod to Wrowmorl s Compensation laws of California Signed . ..........I...... .....I.�..... Owner ` By �1..� pf other thou ....�....� �w�� _ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY . `/�:f��j�,�,h .. .... .. . ...... . . DATE . '3'7 BUILDING PERMIT ISSUED ... . ..... . DATE ............. . . ............ ADDITIONALCOMMENTS .. . ............ . .. .......................................... ............ . . . ............. ... .. .................................... SAN JOAQUIN LOCAL HEALTH DISTRICT �; E.M.13 241 o6A Rev.6M 7/72 3 M