SU0003866 SSCRPT - Laserfiche WebLink

Home Browse Search

I ' f I s FOR OFFICE [ISE: APPLICA71ON rOR SANITATION PERMIT en Permit No. .. ..._.. ._ _...... .. 73 _..... (Complete In Tripliccle) .... ...................... ............................. Date Issued ..`J.?f23... _...................... This Permit Expires 1 Yoor From Data Issued Application is hereby made to the Son Joaquin Local Health Distrix for a permit to construct and install the work herein described. This application is made in compliance with//County Ordinar.:e No. 549 and existing Rules and Regulators: JOB ADDRESS/LOCATION W....v✓�`"�:C.'�.�.'..�:.. GC........._........_....CENSUS TRACT .......................... t(t-.YJ ....... ........ ........ ......Owner's Name Address _.... . _�.: �L.../.../.1... -c city .... .. .j:,.'W!7L.EL................... Contractor's Name ...- f�F""_.2L.. o.�.c.�.♦y..'. - 1""._ic lJ¢'!::.......----..License# -I��3r9 J-._ Phone ............................_ V Installation will serve: Residence[_tf Apartment House Commercial []Trailer Court ❑ Motel ❑Other_.......................................... Number of living units: .... �.... Number o` bedrooms ....Y.Garbage Grinder ............ Lot Size ..Q-. u!�r�lr.:L..----.... B ,R Water Supply: Public System and name ............................................................ ....Private ......................................... Character of soil to a depth of 3 feet: Sand[] Silt❑ Clay ❑ Peat❑ Sandy Loom ❑ Clay Loam ❑ Hardpan a{ Adobe ❑ Fill Material ............ If yes,type.. ...... (Plot plan, showing size of Ict, locution of system in relation to wells, buildings, etcmust be placed on reverse side.l v NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,l PACKAGE TREATMENT [ 7 SEPTIC TANK[ P. Size............................. .................. Liquid Depth .......................... �l w Capacity . Type .................... Material.-.........-.......... No. Compartments ...................... N. Distance to nearest: Well ....................................Foundation...................... Prop. lire ...................... LEACHING LINE [ 7 No. of Lines ........._____.... Length of each line............................ Total Length Depth Filter Material ......._.. ... ...._...................... ,� !! 'D' Box _.......... Type Filler Material . .................. P7i - Distance to nearest: Well ... .................... Foundation Property Line ........................ 1 SEEPAGE PIT [ ) Depth Diameter ..-_. ........ Number ............................ Rock Filled Yes F] No No ( Water Table Depth .. .....Rock Size ................ Distance to nearest: Well .................. ....................Foundation .................... Prop. Line ...................... ro REPAIR/ADDITION(Prev. Sanitation Permit>& ......... ... .............................. Date ..................................1 X Septic Tank (Specify Requirements) .......... �.... o...... . .�...... ._................. Disposal Field (Specify Requirements) .. ...L!.:K. ..�% / " f�... . .... ................................................... (Draw existing and required addition on revere ids) 1 hereby certify that I have prepared this application and that the work will be done in accordance with Son Joaquin _ County Ordinances, Stale Laws, and Rules and Regulations of the San Joaquin local Health District. Home owner or licen- ced agents signature codifies 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 manner as to become subject to Workman's Compensation lows of California." Signed ' .... Owner t B __. ��.9jL'%.( fQ4... Title L�0'. .Id-ste ^'i. ........... . .._.... y pf other than owner) ` FOR DEPARTMENT USE ONLY - 9a� _ APPLICATION ACCEPTED Bl' _.��- lJ..-7-.[ %�'.� .. ........ DATE _g9_.. . ..... ...!. ....... BUILDING PERMIT ISSUED . _.......... ...DATE . ....._...... ..... ... . .. ... . .. ADDITIONAL COMMENTS _. _ . .... .. _. _. __ _..__................................. __.... _ _ _....._......................... .......... AA yy Final Inspection by: . .. . ..,/� .e._ . . at ,r...-.b.'/�'.,,;j..... .. ...... SAN JOAQUIN LOCAL HEALTH DISTRICT tx$ E.H. 9 1•'68 Rev. 5M