SU0001365 - Laserfiche WebLink

Home Browse Search

1 l I FOR OFFICE USE. /i <.-G•� s��%%� APPLICATION FOR SANITATION PERMIT (Complete in 7riplitatei Permit No. _.. ._ This Permit Expires I Year From Date Issued 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 d-G � .�G.. "SUS TRACT ......... .. .......... Owner's Name / r ' ` r7 �9.-,S.ys ....... G.y.L/f'/ . �-. - -NNicG.. . . ...... ._ . . ...._ . . .. .Phone - yy 1 Address ._. I:�.. ��/.. ../.4- ./... - ". �:�Y�.. ..��L�.. .........city ._./ 1/t-.J19... .C,llY1j- ........ Contractor's Name _.._ !`%G/'.. .fwd/✓[-..._...C1,r.S License# 3_.j.3 .3,9e.Phone Installation will serve: Residence❑Apartment House 0 Commercial ❑Trailer Court :❑ Motel ❑Other __. 121,IVL..4_..1 Pea e'60- Number erNumber of living units:.. .. _ Number of bedrooms ......_....Garbage Grinder .. ._.__ Lot Size ....../.?.../--- CS._,••••_., Water Supply: Public System and name ..... ._.._..._.................. ................_._.... --...........................................Privote,�Q Chorocter of soil to a depth of 3 feet: Sand❑ Silt ' ' Clay ❑ Peat❑ Sandy Loam ❑ Clay Loan(_\ Hardpan❑ Adobe A Fill Muterial .... . ..... If yes,type......I..................... (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,) k : PACKAGE TREATMENT [ ) SEPTIC TANK[ ] Size..........)04A/..�i[�.7-,' .Pli�Liquid Depth ......... ._..`.�::......_........ Capacity . Type r<- CajMatertal.. No. Compartments . .. ............... Distance to nearest: Well ........... . . Foundation .a.L"r f��. Prop. Line..... .. ...line � ...... LEACHING LINE [ ] No. of lines :' Length of each line Total Length . .1.>tU.............. 'D' Box `;.0 . Typo Filter Material SfrrT c..rl's4pth Filter Material ................................ Dictonte to nearest: Weil .B V.!✓.-I.f 1) Foundation 6.VW/.01__.. Property Line ._lei.r.............. SEEPAGE PIT ( J Depth a$-r. _-_- Diameter Fj Numbe• —17- Rock Filled Yes m No Q Water Table Depth ....40 r ......Rock Size _. .. . .. Distance to neem: Well ._ �.y4 .. ./.n..�..... ..Foundation .C.Y s._/v yProp. Line _< - REPAIR/ADDITION(Prev. Sanitation Permit# ..: ... _. _. Dote ____........ _.... ... ) Septic Turk (Specify Requirements) Disposo! Field (Specify Requirements) (Draw ex.isdng and required addition on reverse side) I hereby terrify !het 1 have prepared this application and that the work will be done in accordance with Son 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: "t 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 sub;ect to Workman's Compensation laws of California." 5:-nod �r:'H G % /�-lig✓[i- �^u�.j i L<t Owner Title By F DEPARTMENT USE ONLY _ o;!CAT.O.N AC c?TED 6v / -v. DATE - n!i ! C PERMIT ISSUSD / ry ,j DATE _.. 0010CA J/J i ., OU! LOC4L 'HEALTH DIST2ICT