Laserfiche WebLink
FOR OFFICE USE: ' APPLICATION FOR SANITATION PERMIT <br />^ ' �~ }� ~� � <br />------~------' —'' (Complete |nTriplicate) <br />`"—'---------------| <br />| This Permit Ex��s1Year From Date issued <br />k <br />PonmNc, <br />Date Issued <br />��� <br />LocalApplication is hereby made to the Son Joaquin Health District for a permit to construct and install the work herein <br />described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations-. <br />JOB ADDRESS/1-OCATION-4W9-7 ---- <br />owner's Name <br />------------ <br />Contractor's Name <br />Installation will serve: Residence X Apartment House'F­1 Com mercial,:E]Tra i let Court <br />Number of living units:---,/ ----- Number of bed <br />E] Sandy Loam -E] Clay Loam <br />Character of soil to a depth of 3 feet- Sand'E] SiltO Clay El Peat <br />(Plot plan, showing size of lot, location of system in relation to wells, buildings, etc, must be placed on reverse side.) <br />NEW INSTALLATION: (No septic tank or seepa ge pit permitted if:public sewer is available within 200 feet,) <br />u/stonco ,o "=".°," ,,e" ----------------------------------- <br />LEACHING UNE [ \ No. of Lines ---- Length of each line --- ------------------------- Total Length '.__'—'-_'— <br />'0' Box ------------ Type Filter Nkztevo\ --'-----'Depth Filter Material ----------------------- jk <br />Distance », nearest: VVeU..----------------------- Foundation -------- Property Line -----'__.— <br />S[EPAGEP|T [ ) Depth -------------------- Oi'mator ----------------- Number ----''--.— Rock RUe6 Yes [] No <br />---------- <br />Water Table Depth ---------------------------------------- <br />---------- Size ----------- <br />Distoncatvneor m`Ve-U _—'_'—'_-_ --Foundation .'Pnop . Li_ne .'—— <br />(Prev. <br />»— <br />Sanitation Pnrm|t# —'------------------------------------- Dote —'_--__---.--] <br />-----_---�_ <br />--''- Tank —'— ' ' ~ u��-' �� -'—I hereby certify that 1 -have prepared this application and that the work will be done in accordance with San Joaquin <br />County Ordinances, State Laws, and Rules and -Regulations of the Son Joaquin Local Health District. Home owner or licen- <br />sed agents signature certifies the following: <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 />____ ; - --- ------------- / <br />(If other h*�/wnerj EPARTMENT USE ONLY <br />APPLICATION ACCEPTED BY <br />BUILDING PERMIT -ISSUED <br />ADDITIONAL COMM T <br />— <br />Disposal Field (Specify Requirements) ----- C? <br />-------------- <br />Final Inspection by: ----- <br />` l''68Rev. SkA <br />----------------------------------------------------------------------------------------- <br />