Laserfiche WebLink
FOR OFFICE USE. 7L <br /> .....................I._.....:....._:..._. <br /> APPLICATION -_XOR SANITATION PERMIT.... <br /> lCompletein Triplicate) Permit No. <br /> Date Issued . <br /> .......... ........ ............ ...... This Permit Expires I Year From Onto Issued <br /> Application is hereby made to the Son Joaquin Local 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/LONATIONA....... 1-2-u.d ... .............................................CENSUS TRACT ......... <br /> 5 <br /> Owner' . .e . .................Pho ........ <br /> Owner's Name <br /> ............ ................ <br /> Address -------Dk�dfi : w C, <br /> 2K................................ ty oe <br /> _0 <br /> Contractor's Name ---------------- ....... ------*......................License #kal.� 33 'ihone,......e* *23............. <br /> \ <br /> Installation will serve. Residence(3 Apartment House 0 Commercial OTrai Ier Cau rt\O <br /> Motel 0 Other--------------------------------------------- I <br /> Number of living units.•...Z-.... Number of bedrooms ......�.�... rbqqe Grinder ..... Lot Slze\L ....... <br /> Water Supply: Public System and name ................ ............................................. .............................\.I..._.......---Private <br /> Character of s*3 to a depth of 3 feet: Sand 0 Silt 0 Clay 0 Peat 0 Sandy Loom 0 Clay Loom 0 <br /> Hardpan 0 Adobe 0 Fill M6terlal ............If yes,type............... .... ....... <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 seepage pit permitted if public sewer is available within 200 feet) <br /> PACKAGE TREATMENT SEPTIC TANK Size—................. ....... ......... ......... Liquid Depth -------------------- <br /> w <br /> Capacity:..............• --- Type -_---------_---- terial—..... .... ......... No. Compartments .... ......... <br /> Distance.to nearest: Well ........ ........—.. ............Fo dation ...................... Piop. Line ..................... <br /> No. of Lines --------------- ------ . .......................... Total Length .0 <br /> ...................... <br /> LEACHING LINE VLeng------------------------ <br /> 'Di Box ............ Type Filter Material ................. epth Filter Material ....... ................... ...... <br /> Distance to nearest. Well ................ ....... Foun tion ....... ................. Property ,,Llne ..................... <br /> SEEPAGE PIT Depth <br /> --_---------------- Diameter --- ----------- Nu ber ........ ----_-_---------- Rock Filled Yes 0 No 0 <br /> Water Table Depth ----- ------------- -----•-•------•--- ........Rock Size .................... ...... <br /> Distance to nearest- Well ........ ................... ...........Foundation ......... .......... Prop. Line ...................... <br /> REPAIR/ADDITION I Prev. Sanitation Permit# ............ ------------- Date ------.._............_........:...y <br /> Septic Tank (Specify Requirements( .................... . ................................................*..........................................\-­................ <br /> Disposci Field (Svpcity Requirements) ... ..... . ........ . ........... ---• -/-------------V..................... ................... <br /> - - ------------**........ <br /> - <br /> ---------- ---------­- <br /> - I" ------I............... _e--------- -S- ele, ........ <br /> dr <br /> ------ 7.2)............0__X4--------- ------ -- <br /> .. .............................................................*----------------------*...... <br /> (Draw existing and required addition on reverse side) \ . <br /> I hereby certify that I have prepared this application and that the work will be done In accordance with Sdn Joaquin, <br /> County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local Heal&DIstrict. Home own"Lo or 114*n- <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 /> Signe,, ............................. Owner <br /> i. <br /> .y --- ----- -------- - -------- <br /> ----- ------------ ­-------------------- Title ------------------ -----­------- ......................... .......... <br /> (If other than <br /> FOR DEPARTMENT&S <br /> =k PYLY <br /> APPLICATION ACCEPTED BY -----------------••--•-•--.....--------.._..- DATE-'_ -S.1:24�--------------\ <br /> BUILDING PERMIT ISSUED ............................••---•--•---•--. <br /> ADDITIONAL COMMENTS -_--------------- ---------- --------- ........ ......DATE <br /> ................. --..-----------------------------•-•--•-•--•----•----------- ---------------•---- <br /> -------------------------- ---------- ---------_1------------­­­­--------------- ------------1*11*1­------ ......................................... .......__------------------ <br /> ------------------------------- ..................... --••------...---- -----.--------------------------------------------------------------------------- ............... .............. <br /> ---------- ----- <br /> . ........................ <br /> ................................. .....................1--.......... ...... ..Date . ............... <br /> --------------------------------- •"­-------*-­-----------------­*--------------------*-----------*------- <br /> Final Inspection by.- _--------------- �., -/, xW7--------------- <br /> EH 13 24 1-68 Rev. 5m SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M <br />