SR0085108_SSNL - Laserfiche WebLink

Home Browse Search

�d FOR OFFICE USE,.. APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. 73%... . _ This Permit Expires 1 Year From Date Issued Date lisued Application is hereby made to the San Joaquin local Health District for a permit to construct and install the work herein described. This application its Made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/1- OCATIO /8,5c. j-�'-�`. l CENSUS TRACT Owner's Name' !! .. n r.-.....�2-fii �...-...... - ..Phone ............. . Address.. . ............. .........�.... ....... ............_.... _......._.... City .... �' 4 �.. �c �......... .......................... Contractor's Name .�lt�t.4...fi/...7t.._.1iiv-i.Q� .License # 1r�3� 2r.. Phone .............................. Installation will serve: Reside4ee ❑ Apartment HouseCommercial Trailer Court ❑ fl Motel ❑•Other ........ ..--•- .............................. - Number of living units:........ .. Number of bedrooms ..... r ...... Garbage Grinder .. ...' .. Lot Size ............. Water Supply: Public System and name y . Private Character of soil to a depth• of 3 feet: Sand Silt ❑ Clay ❑ ,Peat E]Sandy Loam,C] Clay Loam ❑ Hardpan p Adobe -❑ Fill Material If -yes, type ............................. Mbt plan, showing size of lot, location of system In relation towells, buildings, etc. must be placed on'reverse side.) °h NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,)!/ PACKAGE TREATMENT [ ] SEPTIC TANK Size`- �.x....3_�?... ;-.e. �1 `/ Liquid Depth ..7:... ..................... pi . C.... No. Compartments ...."�4..........: i •,r Distance to ned est: Well .......�5r?...................Foundation ......09... '.:: Prop. Line'...... �..... ........... LEACHING LINE[ ]c� No. of Lines .......�....... _. Length of each line ...... tt?.P....... Total Length :.... 4. .......... 'D' Box ' � Type Filter Material ....5-'R '.---.Depth Filter Material ........Ie) /; .......... .................... Distance to nearest: Well ...l Jr................ Foundation .....�'p I ........ -. Property Line ........................ Depth ............ LT sr .X.�'...._. Number ... .... 3 ................ Rock Filled Yes No Q Water Table Depth ................ �t3....._....`..._. .. •-•----..Rock Size ...'. �...... Distance to nearest: Well ...... ..�:`�4'..�................... Foundation .... /..Q...'...... Prop. Line .... a...�._....._. '�A J REPAIR/ADDITION (Prev. Sanitation Permit +........................................ Date ................ 1 Septic Tank (Specify Requirements) ............................. ................................................. .. ...................... ...... 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: "I certify that In the performance of the work for which this permit is issued, I shall not employ any person In such mattnor as to become subject to Workman's Compensation laws of California." Signed........ ................. .......... .. Owner By e��?t`^l:jz7itle .... .�..._.ner). �1mit �G[ �r C��- ...................... (if other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY. ��-.•.• DATE .' % ..:.%.-' ...... BUILDING PERMIT ISSUED .i:......... GATE ..................... ADDITIONAL COMMENTS ............. .. ......... ........... ......... .............................. .......... ....---..... Fina Inspection by... .... c� ��..........Date - ... SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1 •'68 Rev. SM