Laserfiche WebLink
Metadata
Document management portal powered by Laserfiche WebLink 9 © 1998-2015 Laserfiche. All rights reserved.
FOR OFFICE US�- -------------- ApPqCA71PN -FOR SANITATION PERMIT Permit No. <br /> (Complete in Triplicate) Date issued <br /> S-------------I -----------------•---------- _ <br /> This permit Expires I Year From Date Issued -7 1 C>- <br /> -------------------------------------:--------------- -A" 0) <br /> aS <br /> 'i"Joaquin Local Health District for a permit to construct and tall the work herein <br /> Application is hereby mode to the Son ordinance No. 549 and existing Rules and Regulations- <br /> described. This application,is made ih compliance with County <br /> 71 1 1 ) -------------CENSUS TRACT <br /> JOB ADDRESS/LOCATION ._ -- --- - -----X----- --- -------- <br /> 0 V_S Phone <br /> –,C4�)----------------------------------- <br /> Owner's Name --- --- ------------- <br /> -------------------------City -----S-W-11---------------------------------------------- <br /> -M� <br /> Address ------------C12A------ ------ <br /> License# AA-17-A-9----- Phone <br /> ------------- --------- <br /> Contractor's Name -----SP-IF--------------- --- ------ -[].Commercial.oTroileir,Court <br /> Installation will serve. Residence 0 Apartment House <br /> Motel []Other ----------------------------------------- Lot Size <br /> i Number of bedrooms ------------Garbage Grinder ------------ <br /> Number of living units:- __ -__Private El <br /> Water supply, Public System and name ---VAt- <br /> -PeatSandy Loam []I Clay Loarri 0 <br /> ] o <br /> Character of soil to a depth of 3 feet Sand 0 Silt.[ Clay <br /> Adobe- Fill Material ------------ If yes,type ------------------------ <br /> Hardpan E] I I — -1 — <br /> must be placed on reverse side.) <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc_ <br /> itted if public sewer is available within 200 feet,) jj <br /> NEW INSTALLATION: (No septic tank or I seepage pit perm <br /> Liquid Depth --- ------ <br /> 4 <br /> PACKAGE TREATMENT SEPTIC TANK Size_lQk5i?5�5--------------------------- I <br /> N.- Compartments ------ <br /> Copac1tyk_aWQ2%-_ Type -------------------- Materia <br /> + Foundation A0 ----------!Prop. Line ----------------- <br /> Distance to nearest: Well __`�--- )e 1. <br /> --------------- Length of each line- ----- I-'.ten ------I_Q(--------------- <br /> No. of Lines ---4L ------.0-Ir - I <br /> 'D' Box <br /> LEACHING LINE er Material Depth Filter Mcrierial --- <br /> I&&- Type Filt I " Line <br /> Distance to nearest: Well _;W----------- Foundation __�O---------------- Property <br /> I------- Rock Filled yes Nd' <br /> Number --------------------- <br /> SEEPAGE PIT [ ] Depth Diameter <br /> Water Table Depth <br /> Rock Size --------------------------------- <br /> ------------------------------------------------ ti <br /> Line I ------- <br /> -------- Prop <br /> Distance to nearest- Well ------------------ ---------------------Foundation --- <br /> --------- <br /> -Ilk I <br /> Date ---------------------------------- <br /> REpAl )DITION(Prev. Sanitation Permit -------------------------------------------- <br /> --------—-------------- <br /> Septic Tank (Specify Requirements) --------------------------------------------------------7------------- <br /> -------------------------------------------------- <br /> Disposal Field (specify Requirements) -------------------------------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------- <br /> ----------------------------- -------------------------------------------------------------------------------------------------- <br /> ----------------------------------------------------------------------- ide) <br /> - <br /> ---------------------------- <br /> ion on reverse si <br /> (Draw existing,and required addition in accordance- with Son Joaquin <br /> I hereby certify that I have prepared this application and that the work will be done <br /> of the Son Joaquin Local Health D1stj(4.-,Hame..owner or Heim- <br /> and Rules and Regulations <br /> County Ordinances, Stat® Laws, <br /> sed agents signature certifies the following- for which this permit is issued, I shall not employ any-porson.ill such manner <br /> "I certify that in the performance of the work <br /> as to become subjectto Workman's Compensofian laws of CAllifOrnici-" <br /> Signed <br /> ------------------------- - Owner f <br /> jitle --------1­1_1��7----------------------------------------- <br /> By ------------------------------------------- -------------- <br /> ------------------------- <br /> ----- <br /> (If other than owner) <br /> FOR DEPARTMENT USE 6N�_ <br /> -77---------------- <br /> ____.�DATE ------ -r--- --------- <br /> Y - -- -- - -------------------------- ----- ------------------------- . . <br /> APPLICATION ACCEPTED 8 ------- _DATE- ------------------------------------------- <br /> ---------- <br /> BUILDING PERMIT ISSUED -------------- -------------------------------------------------------- -------------------- ----------------- <br /> --------- -- --- --------------- - -------- <br /> CLA. .1 -- -- - - ------ - <br /> --------- ------------ ------ ' jA <br /> ADDITISN L.COMMENIL -A A�_ J� <br /> \9A —---------- <br /> - - -- -- ------- ------------- - <br /> ---------------------------------------------------- <br /> -------- ----------Date ---- ----------------------- <br /> ---------------------------------------------------------------------- <br /> Finno 11ns&4&" h --------- fr <br /> - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />