SU0014620 - Laserfiche WebLink

Home Browse Search

/c/ 3J-00 1 r0R OFFICE USE: FOR OFFICE USE: -+APPLICATION FOR SANITATION PERMIT - .............. .......:............... (Complete in Triplicate) Permit No....79 . 1 .. Date Issued_,. ?.- .- ................................ ... .................., 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� t. �. .p �G/'U/ r �.C.Z!......i<<,L..-.--. G-fS.. _ GtT...................CEN5U5 TRACT........... _ Owner's Name..:_..- <-... .IDS.%_ ........................... ..................................................Phone..._... .. . c Address........IS.;�.7.........w------- .� ............ ............................... --.Ci 7$<--Y. .Zi 4- Contractor's Name........A.4... .........................................License #.'7/�. .....Phone.8s` .y .7.... co �n Installation will serve: Residence fA Apartment House❑ Commercial ❑ Trailer Court ❑ .1 - Motel ❑ Other.............................................. A! G Number of living units:...{...........Number of bedrooms c,3-.....Garbage Grinder............Lot Size......./. ....-..--------------I................. Water Supply: Public System and name.................. ................ ................................ .............................................................Private Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam 14 Hardpan ❑ Adobe ❑ Fill Material............Wyes, 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,) _ /V -PACKAGE TREATMENT I ] SEPTIC TANK j .......... ................Liquid Depth ..................... Capacityl ........TypeftCF..."XMotcrial..................-.....No. Com artments......a......................... F� Distance to nearest: Well.-..... .......,....................Foundation...lQ................Prop. Line...b ............... LEACHING LINE I ] No. of Lines.....}....................Length of each line:-.*-O..__...............Total Length ...................... • 'D' Box....J..:-._Type Filter MaterialDepth Filter Material...__..../(•1f............:................... ..... Distance to nearest: Well...Mv................Foundation...15.. ..............Property Line....'. .... ............ .. WI .. ... SEEPAGE PIT [ I Depth................Diameter.....-,..............Number::...::-.::..................... Rock Filled Yes ❑ No❑ Water Table Depth...... - .......... ................... ...... ........Rock Size..._........................................... Distance to neorest; Well...... ........................ ..........Foundation...................... ...Prop. Line......................... s r REPAIR/ADDITION (Prev. Sanitation Permit#:..................................:.._,_.,-.'}Dote-........................--......:._.._.._....) Septic Tank (Specify,Requiremen`tpl..................f.... .................................._`?1....................... .................. ............................... DisposalField (Specify Requirements)...................... ....................................-- -----'.--.....---.....................i............-.................................. ................................. :........R....................-...._-........._............_.:....._-_-.._:.-......... -,........................-......-.......... .....--............................._.. ...... ............ .i............................. ..................................................................... ... ....-Y...._..........._........-..:........................................... (Draw existing and required addition on reverse irde) 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 licensed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner as to become Fubject to or an's Compensation laws of California." Slgned.....:.._�c _ _...:... Z✓..............................................Owner By.......................... .......:.....................................................................Title....................... ...................... (If other than owner) -FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.,... -.- d_._..DATE -. .."-�r.?>................ .. _ .... DIVISION OF LAND NUMBER...............:..........-- ............................. �-_ ....DATE.-.........:-..-................................ ADDITIONALCOMMENTS-._.............._.:.-......_._..... ......:....._._-.....:-..._.................._......._....._...__....--.................................................... ..............................,.........................................................................I................................................._..._.._......._....._........... . .... _........................._.......................................-......................................................................I....---- .......................................... ... ...... ..................................................................... .. .................. ..... Final Inspection by:...... .. .. ....... ................... ...- �f= ............... .. .... .-..........-.......Date..._........ ........ . EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT - Fss 21677 REV. rna 3M r�