Laserfiche WebLink
'Y <br /> -IVA OFFICE USE. APPLICATION FOR SANITATION PERM 1,6—.3S3 <br /> Permit No. . .............. <br /> ..........:.:..................I....-::....-••-• ........ lComplete in-Triplicatol <br /> ......................................•--•--....:--.--... ' . <br /> - Date Issuecl .12 --------- <br /> ........... ............... ................. <br /> This Permit Expires I Year From Date Issued.... <br /> Application is hereby made to&'S'an Joaquin Local Health District for a permit to construct and install the work herein <br /> described. This application iv.mode incompliance with County Ordinance No. 549 and existing Rules and Regulotioni- <br /> ...................................aNSUS TRACT <br /> 6�1/ !.. - --V <br /> JOB ADDRESS/LOCAJIm �5.r t�--- - � <br /> Owner's Name t4t%A ............. -P ne <br /> .. . ..................................... <br /> It 10---- n <br /> ......t�.... .....I.......... --------- <br /> Address -----�59,7-,V 40-A/e ot—, ......................... city C. <br /> Contractor's Name ...............;........License# �fJA,77*kf.... Phone <br /> 4 <br /> Installation will serve.. Residence P-op-artme-rit HO'us*O Commercial OTraller Court 0 <br /> Motel []Other............. <br /> .............. <br /> Number of living units------------- Number of bedrooms :Garbage Grind& ........--.10t.size <br /> Water ............... ............ <br /> 7- <br /> Supply: Public System and name ............................................. ..................-................. ..........Private JE / <br /> Character of soil twa-depth-of-314et- :�'ScthdE] -.-Silt.orl;�-Clay-�0--"-Peot-0-'-SarfdV-Loom-O � Clay Loam-0- <br /> Hardpan C] Aclob;0 Fill Waterial ............ If yes,type.............. ... ........ <br /> i (Plot plan, showing size of lot, location of I system In relation to wells, buildings, etc. must be placed on reverse," side.) <br /> IIIt r 4f public sewer is available within 200 feet;(NEW INSTALLATION: (No septic tank or seepage pit permitted ov <br /> PACKAGE TREATMENT SEPTIC TANK I Size.'....•._ ......................... Liquid. Depth.-----------.............. <br /> J <br /> ..... . <br /> Capacity ............... .... Type -•-----•---=-...... Material...................... No, Compartments -- ............. <br /> - <br /> Distance.to nearest: Well -------------- .....................Foundation ...................... Prop. Line ..........:........... <br /> ............... ... Length ..... Total Length __......-_-•-............... <br /> LEACHING LINE I No. of Lines th of each line....... .......... <br /> D' Box ... Type filter,Material ....................Depth filter Material ... .......... ............................. <br /> 'Distance to nearest. Well ...:............:...•-- Foundation ................... Property Line ......................... <br /> SEEPAGE PIT Depth -------------------- Diameter ................. Number .......... .......... ...... Rock Filled Yes [3 No C) <br /> Water Table Depth ......... .............................I.........Rock Size ......................... :715 <br /> Distance to nearest: Well ......... ........................z... foundation ...... ........ Prop. Line ......................(t <br /> 'REPAIR/ADDITIONIPrev. Sanitation Permit` .................--•.••-------.--•-----•-- ---------••-------------•) <br /> Septic Tank (Specify Requirements) ..........-...... ........... ......................... ... ... ............................. <br /> 011 <br /> . ...... ..... <br /> Disposal Field (Specify Requirements) -----------�.W <br /> 4c <br /> ... Ae�----------- <br /> 4C t. -+ ... -!!�F ---70- <br /> ------...... ......... <br /> .............. <br /> ................. <br /> ...------------ ...... ----------------- ........................ <br /> ----- ............... ........ ........... ............. ..................... <br /> (Draw existing and required addition on reverse side) <br /> J <br /> I hereby certify that I have prepared this appllebtlonancl,that the work will be done in accordance,wt#Ir Son Joaquin <br /> County Ordinances, State Laws, and Rules and Regulation.s"of thei Son Joaquin Local Nealth�blstrict..Horne owner of licew <br /> sed agents signature certifies the following: 11 -' <br /> "I certify that In the performance of the work for which this permit is issued, I shall not employ-any person In such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed -------------- ------------------------­­...... ------I...Title Owner <br /> ..... . <br /> ....... -------------------------------- . (!a C: <br /> Z other <br /> DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ----------- ----------•---•--- ---- ---------------------------- DATE <br /> BUILDINGPERMIT ISSUED ------------------------------w.................................---------------------------------------DATE ........................................ <br /> ADDITIONALCOMMENTS ------------ ------------- ------------- ---------------------------._-.....-.----=----------------------:....--- -:_...--•-•-....._---...----- <br /> ..............................................................-..........................................-.......... ......... <br /> - ------------------------------- ---------------------------------------------.......I---------------------------------------------- <br /> ----------*-----------------------------*----------------------- <br /> ...............------------- <br /> ......... .......Date - --- ---- ------------- <br /> --------------11-1-------- ---------------------------------- ----I--------------------y- <br /> finol Inspection by; ------------ V <br /> EH 13 24 1-66 'Rev. !N SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M <br />