SU0013585 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. _V`-X11 ---- ------ - -- --- (Complete in Triplicate) - ------ ------- ------ - date Issued ---- ---- .--- ----- ---------- � This Permit Expires 1 Year From Date Issue he work Application is hereby made to the San J ""quip Local Health District for a permit and exist ng Rulesto construct and talndt Regulat onsrein application is made in r I' n w't Coupty Or described. This app ' "s �Y1g f i y CENSUS TRA41 CT s •------------ JOB ADDRESS/LOCATION � �- Phone ------ --------- -= ------------ Owner's Name _-..: ----------- Address ---- ..ty--- --- ------- -- - City -- _ .--- - 8 •`�-.License # 3 v Phone .. Contractor's Name --- -- - - -- ---- �Z_.. . -�w - -�..-.--- -----•- - Installation will serve: Residence f-] Apartment House❑ Commercial ❑Trailer Court-❑ Motel ❑ Other ------- :- ------ ---- ----- ---• _ -------- Number of living-units:._-_--......Number-of-bedrooms __.........Garbage Grinder '_`_---- Lot Size Private N Public System and name ._..________-._-__--.----- _ __ .-- ----- . Water Supply: Y �`Clay Loam.m Character of soil to a depth of 3 feet: Sand T-1Silt F] clay Clay ❑ ❑ Sandy Loam ,esa ------ ".-- ------ Hardpan ❑ Adobe 0Fill Material ............ If y type (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) itted if NEW INSTALLATION: {No septic tank or seepage pit perm ;public sewer is available within 200 feet,) 1 . Liquid Depth .--- PACKAGE TREATMENT [ SEPTIC TANK''[ l Size------'_�,----------------- ------ ------- - No. Compartments ....:................. Capacity_..'.'---' Type.,-------------------- Maferial"--- ------ - I E _ . . Prop. Line ---• -------------- Distance to nearest: Well .................•---_--------- --_-Foundation ----------------- LEACHING LINE No. of Lines _.__..___- 9 - _ Length of each line-------- ----- --- -- Total Length ----------- ---------------- [ } 1 Depth Filter Material _ __ 'D' Box Type Filter Material ----- __ ------- - - -- Distance to nearest: We -------------- -- ---•-•- Foundation Property Line ------ -------------- S l' --- .----__._ Rock Filled Yes [� No ❑ Depth - ..v� .. Diameter __77-6Number SEEPAGE PIT [►j P - - — ~~--f� " 3 " --...Rock Size . - 5 f Water Table Depth ---_-------�©--------�-------• --- � 50 t------------Foundation ------�•------•--- Prop. Line .--- ••----•-- Distance to neare'sl': We11 Z;..'---'; --------- Date ----- -------= -----1 REPAIR/ADDITION(Prev. Sanitation Permit# ------------ ------- - ., -3 Septic Tank (Specify Requirements ............... j �v► i /1 % - t Disposal Field (Specify Requirements) - _------•- ------ - ..........- -------- - - . --- "••-- ---••- ----•----••-......----•-_-- -------- ------ (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: k for which This permit is Tissued, I shall not employ any person in such manner "I certify that in the performance of the wor as to become subject to Workman's Compensation laws of California." Signed _-.............. . ; ------...-- Owner .' By ------------------- ---------------------- -(I --- -----L . Title 'l - (If other than owner) It FOR DEPARTMENT USE ONLY - - - r ------------------------------------------ DATE _�d' --------------/-- -•------•-. APPLICATION ACCEPTED BYE'- •- - BUILDING PERMIT ISSUED _---_------- -•--- .................................................""•----- ....... DATE - ---..--- ADDITIONAL COMMENTS ------------------- -----------------------• -------"--••---- ,. ........................ -- -------------------• --------- - --- Dat -.d-` - -- - ------- ---------------- ---------- -- Final Inspection by: -- -.--- - �-------------................. " SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev..5M. f