SR0082194 SSNL - Laserfiche WebLink

Home Browse Search

31 FOR OFFIC USE: — - APPLICATION FOR SANITATION PERMIT FOR OFFICE USE: (Complete in Triplicate) Permit No.. ...... _ ...... ------- ........................................................ Date Issued..-/—.�j~-.7� --------------------------------------- ----------------- 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 Rules and Regulations: JOB ADDRESS/.LOCATION J O.._UO....... I�4�. I�QN...: ....�-,r.`•._......._ .__.............:.•. Owner's Name. - US..TRA ../.........................G / � t�..__d- � �41�t�.... + - ...... •:••. SPhone. .7 .. Address.__ .._&/. - ��•- --- -- - �- - ..city .._ _ --Afic,J---- -- ----- Contractor's Name..! ......_... ...... # Phone--- -._ - .............. --.._ ._._.. --- ................................. Installation will`serve: Residences ApartmentHouse.❑ Commercial ❑ Trailer Court ❑ Motel ❑ 'Other---- ------------=- ----- •---------• . Number of living.units:---!-?_,_"�-N�7�inbe of bedrooms:` .___._.Ga"r'bage Gririder__...'..__,.tot Size._._____...s_ 1 =�1 _ Wafer Supply: Public System and name .......... ....<--:..,.....-•---,.......:- ..-----•_.... .............-:.:Private Character of soil to a depth of 3 feet: ' Sand I] 'Silt❑-`CIby g3. Peat=❑ Sa dy Loam Clay Loam ❑ I Hardpan ❑ Adobe ❑ F;II 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: (Na septic tank"or seepage pit permitted if public�wer ;s avail je within 200 feet,) t d i PACKAGE TREATMENT ( ] "SEPTIC TANK DQ $ize~f_IA�LpF.Ilf_LZCt^ ..`'Liquid Depth............................ i Capacity-/(0(L0hype...:...---.?...__...-Material--- -------------•-•- .No. Compartments_--------------------------- Distance --•--------••-•---• Distance to nearest: Well.� . .. ,�Q../57t.................Foundation---.......--•��---.Prop. Line...Z.�,S..�T.-� LEACHING LINE [ J No. of Lines .._.;-a.:.......:........Len Length of each line.•.....�:_�..�,:1__.....___.Total Length ..__. z .___ g .. j 'D' Box............Type Filter Matetial--.-_:-----.'_.__.Depth1Filter Maferaal................. ...._..:......—-��.--:--�-_-- F -Distonce;fo nearest:YVell_ t _..r/" , Foundation.'-Z __j�`/_�T_.•-....Property Line..._ZS_1T _. SEEPAGE PIT [ ] Depth...__.._-.,---.Diameter..:..................Number�._.j-..-..�_....!_---- Rock Filled Yes No y. ., Water Table.Depth------------------- ....._....-_.. ... ._....:Rock Size..........._..c 3 Distance tb nearest: Well..: 1..Foundtdtibn.......................'..Prop. Line_........................ REPAIR/ADDITION (Prev, Sanitation Permit#-. __...--.----.-..............:..:__.::_...._..Date_f.__.:.,.':,:__--_-_--__........:_.._...__.] ' Septic Tank (Specify Requirements).........:....<_...................-\_ '�.=`Z� :.,_ " . _- t Disposal Field (Specify RequA'rx,�i n, s)._ _..... -._ Y ._`. �..__:.. t...._. :n�ki : 1�1L2 .... :.+ '- _.......... �� '"`a -• -----• ---••-....... ........• --- ............................•:-_----•- .......-----:--•---.....--................................... (Draw existing and required addition on_reverse side) 1 hereby certify that Itihave prepared this-application and that the work will be,done in accordon&-Nm ith,San Joaquin County Ordinances, State Laws; and'Rules'and Regulations of4the satt Joaquin Loca`hHealth District, Home owner or licensed agents signature certifies-the:followiri r:^ I ceitify'th«t in the performance Af work`for w jcFi this permifis issued, 1 shall not employ any person in such manner as to become subject-to�Workm�- cam' e satioii"lbw' a�lifornipP' "`r' i Signed.......... .... Owner: t By--........................................... --------------. Title_! (If'other than owner] x' _ ( FOR'DEPARTMENT USS N Y' r APPLICATION ACCEPTED BY_--------- DIVISION OF LAND NUMBER........_..;.........:. ............ :��... .......---...._..........:-----....DATE-------------------------------------- ADDITIONAL COMMENTS............ ................. ...........-• •--•----...---•-------•----------......._......_...............-- •-•-----•---- ----------- ---------------------------- --- ---- ------------- __...••=......--=-••- --•. ------... ......---............... ------------.--------------------------------------- ------------------------------------- -- -----•....... ........................ Final-Inspection by:_. = "-- -- - -: --------•--------.:. Date.... 7 e 3M 75� EH 13 24 SAN JOA UIN LOCAL HEALTH DISTRICT F&S 21677 RFV /7 I