SR0083887_SSNL - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: OFFICE USE: Permit No.�'$�-3 APPLICATION FOR SANITATION PERMIT FOR OF __..................... _........_........ (Complete in Triplicate) •••• Date Issued ••--•-•-• ................ This Permit Expires 1 Year From Date Issued L Application is hereby made to the San Joaquin Locol Health District for a permit to construct and install the work herein described. This application is rnade.ua-cornplion ce With County Ordinance No. 549 and existing Rules and P,egulations: JOB ADDRESS; LOCA�yTION__ll ��_��j�D�,a RiM3774- 1� _ (S' V.,. ;A.�nmx- �&kC,7,� RJ CENSUS TRACT ..... 0�f55-v7o-ZJ Owner's Nome. 4C�1Ls11 uTC�yV i....TrQEi....................................... Phone Address p. �OJ'�.1 . ��S �i�i� .......... .............................. . ....... . City Contractor's Nome .._............... ............ .......... ......... ..... . License #.... ......Phone ......... .........-.._.. .-----.. Installation will serve: ReAence ❑ Apartment House ❑ Commerclalx Trailer Court [] Motel f Other.. _. Number Of living units:.... Number of.bedrooms-.------- Garbage Grinder. .....lot Sim-, ........ . . . ........... ............... ........... Water Supply: Public System and name............. ..............•................ -2..........__........._..... ....... ..... ........... _...,,.... Private ❑ Character of soil to a depth of 3 feet: Sand [. Silt ❑ Cloy ❑ Peat X Sandy Loom F7 Clay Loam ❑ Hardpan ] -rAdobe ❑ , 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.) �N NEW INSTAL LATION.='(No septic tank -or seepage pit permitted if public sewer is available within 700 feet,) O PACKAGE TREATMENT [ J SEPTIC TANK [ j Size - .. -_. �. oZ,Q�-------- Liquid Depth Capacity . .. .Type ..................... Material-.. ......... ....... ._No. Compartments- 2- i Distance to necrest: Well 2.4 0. .............. Foundation Prop. Line s. .......... LEACHING LINE. [ J No. of Lines . 1 ...-.. length of each line %OO ....Total Length ....f�... ` 'D' Box Type Filter Material....................Depth Filter Material ...-----......_.. ............... ( Distance to nearest: Well ........:......... Foundation ................. Property Line .............. SEEPAGE PIT [ ] J Depth :... . ,_._Diameter.: _...j...........Number............ Rock Filled Yes ❑ No F, Water Table Depth--- ----.-........; . ........ ............ -.... -..._._Rock Size .............................. Di sconce to nearest: Well ............ t.,......; ................. . Foundation ................ .......... Prop, Line .. REPAIR: ADDITION (Prev. Sanitation Permit # .................. ..*....... .............. • .. Date ...... _... _....... ... ............ j Septic Tank {Specify Requlrerrlents) Disposal Field jSpecify Requirements) ................N., »......................... ........... - _................. _..... ...................... .-.... _----_.................................. I.. ......__..........._•............... '............. _.............................. ........ � (Draw existing and required addition an reverse side) 1 hereby certify that I have prepared this application and that the work will be done in accordance with- San Joaquin • Cott;•,ry.- Ordinances, State Lows, and Rules and Regulations of the San Joaquin local Health District, Home owner or licensed agents '1, signature certifies the following "I cortlfy 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 Workman's Compensation laws of California." Signed _- __. v.t �{I�t-acroS ...Owner By ......-----........_�._Cr�^.G. � _cam �.�-.1T.GYi .....__...........»......_.. Title ... �2 C1 /� C1Lt......................................... t (If other than owner) FOR DEPARTMENT USE ONLY '\PPLICATION ACCEPTEDBY...... ... ._....------• .................._....._:...._....DATE -� �.Ljr . .7 DWISION OF LAND NUMBER:.......------. ----•---------•-•---=-----=---••---•-••---...----.DATE............................... ADDITIONALCOMMENTS.. ........ ..............:.._......------------------------•---•------•................................................................. ,... 1 - it ....................................................................»................. ............ ........................r.._-_.... ....... ............. ........... ............................ �- ...»....-...__.-__..............:................... ... - - - - -- - - .. -.. _----•-..._.... _------- ---•----------------------- ..................................................................................... .................... __ ....--------------------- ................ ........ ._..........-. _.. _.. ......_................._.._.....HE..._..»...__..__...____-___. _.. _. f�} p ------- _.._.._._._..... _.. Final Inspection by:....... _ _.. . _ . Date J ! J 1 ."............... . EN 13 24 SAN JOAQUIN LOCAL ALTH DISTRICT FAS 21M WV. 7izdsM