COMPLIANCE INFO_1987-1992 - Laserfiche WebLink

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(Complete in Triplicate) Date Issued .. G`y/6p ...... ................................. .............. This Permit Expires 1 Year From 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 RulesPs: /� n t 1 JOB ADDRESS/LOCATION ------ AW. ._..,...Lgr.®-...---CW_1:-..-1.:-�1-��•j•�•�M-I�1✓CENSU TRA Owner's Name f J.i'�.W:�j.Q... «�-I •�-t°. ........................ :» ,r.�. Phone .................................... Address :. si tes . S _:�D l .._........................... QiyV {' ...... .. - ..... Contractor's Name .... .L- ..-...... lea _ gl-..................................Licensec (/x3 Phone �.eZ316.6tey Installation will serve: Residence ❑ Apartment House ❑ Commercial railer Court 0 / Motel ❑ Other ............................................ Number of living units:... ....... .. Number of bedrooms ............Garbage Grinder ............. Lot Size ............................................ Water Supply: Public System and name ................................. - ..................... ..... ........................................... Private Character of soil to a depth of 3 feet: Sand ❑ Silt ❑ Clay ❑ Peat ❑ Sandy Loom ❑ Clay Loam ❑ Hardpan ❑ Adobe ® Fill Material ............ If yes, type ............................ (Plot plan, showing 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 (] SEPTIC TANK ] Size...'J^y....iquid Depth .. 'r .z ....... Capacity ./.rte A... Type CA. .....................: No. Comparttments ...�_.... �...._. Distance to nearest: Well ....6Mf..................Foundation ..... ,,L.Q........ Prop. Line .... 6.............. LEACHING LINE (j . No. of Lines Length of each line ..... _:,170............ Total Length __2 'D' Box ............ Type Filter Material ....................Depth Filter Material ............................................ Distance to nearest: Well ........................ Foundation ........................ Property Line ........................ SEEPAGE PIT (j Depth .................... Diameter ................ Number ............................ Rock Filled Yes o Water'Table Depth . ---......--• ....................•----...-----..Rock Size ................................ Distance to nearest: Well ........................................Foundation .................... Prop. Line ...................... REPAIR/ADDITION (Prev. Sanitation Permit #............................................ Date .................................. SepticTank (Specify Requirements) ------------------_......_..............----....----......----.................................................._..................•-•_.... Disposal Field (Specify Requirements)..............................................................................t ...................................................... 1 _.... _. ............................................ _................................. .......................................................... (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules 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 the work for which this permit is issued, I shall not employ any person in such manner as to become subject to Work 's Compensation laws of California." Signed ..... ........ ..........---.... _.......t._-- ---- Owner By... ... ........ ... .... .. .............. J'itle-------- � . (if other t an owner) FOR DEPARTMENT LY G APPLICATION ACCEPTED BY • ... .............................. ................... .... ...... DATE 1L."f�'.1.........---•--....... BUILDING PERMIT ISSUED . .................----------- ..... .... ......._...._._......DA ADDITIONAL COMMENTS ... .._................................... ----.......------.._..------............--- ..........-- •----••---•. ..........:..............._..------.................------........t.........--------•--......... _ --------•®ale. .'./-�a ...................... ..... . .... Final Inspection by: ........... ......•-----.------------- -- SAN JOA IN L HEA D ICT E. H. 9 1-'68 Rev. 5M _ _=