Laserfiche WebLink
FGR OFFIC-M Li'Si:: <br /> APPLICATION FOR SANITATION PMIT // f <br /> ............. ......................... In Triplicate) Permit <br />..........,.......................................,.... ' ®cite Issued <br /> ........................ .. ... . ................ ThleVermIt Expires f Year From Date Issued <br /> Application is hnreby mane to the Sar: Joaquin local Health District for a permit to conei'rust and Install the wont -hero#ri i <br /> described. This opplicotion Is Heade In compliance with County Ordinance No. 549 and existing Rules and Reoulctions: <br /> JOB ADDRE:SSAOCATIoN ..ZQp!. ............ . ...-CENSUS TRACT ...... <br /> Owner's Name wmlewn.,�..................... ............................. ... ..... ........... <br /> . .... .phone <br /> Address P-I(•..Cx � � ............ ......�...�... :.......... � <br /> � <br /> Contractor's Name ........................................................................................license # ........................ Phone ....... ..................... ' <br /> Installation will aervat Residence®Apartment House Commercial {3Traller Court C3 <br /> Water Supply: Public system ❑ Community system ❑ Private �epth.to Water Table ft. <br /> �. r •1 . 1 .1 r w r .. r 1 n I-` x I n f_.__L. i __-- I--I !-`I_.. I ___ 1--1 f"I rl A-j-L.. <br /> WaterSupply: Public System and name ..............................................................................................................Private <br /> Choractor of soil to a depth of 3 feetr Sand IM Silt[❑ Clay ❑ Peat[❑ Sandy Locant ❑ Clay Loam C3 i <br /> Hardpan Q Adobe 0 Fill Moteriol ............ If yes,type ............... ............ <br /> (Plot pian, showing size of lot, location of system in relotion to wells, buildings, etc. must be placed an reverse side <br /> NEW INSTALt.ATIONi (No septic tank or seepage pit permitter! If fluidic sewer is available within 200 feet,) <br /> PACKAGE TREATMENT ( I SEPTIC TANK PQ Size..����r�.�_.$�t�e��{�..�'�'`�.�. Liquid Depth ...l'p- : .......... <br /> Capacity AP.Q..G.04. 'type .................. . Materialt 9 .. No, Compartments ..... ....... <br /> Distance to nearest: Well ......... .............I.......Foundation ..f�. ........... Prop. Line .. ........ <br /> I. <br /> LEACHING LINE Dd No. of lines ........R.—........ Length of each line....49. ....... Foto! LengthYev-al .......... <br /> f 'D' Box ... .... Type Filter Material IPA....—Depth Filter Material ....................... <br /> L7istan"te wn®artist:-Wen:::�?��.._:�:..... t•oundiati�n � �P'rop�rty tins <br /> SEEPAGE PIT Depth .................... Diameter <br /> ................ Number .......... Rock Filled Yes No <br /> Water Table Depth .......----•....................................Rock Size ............. .................. <br /> iDistance to nearest: Well ........................................Foundation .................... Prop. Line ...................... <br /> 4 REPAIR/ADDITION(Prey. Sanitation Permit# ........................................... Date ................................. .j r <br /> SepticTonk (Specify Requirements) ..................._._................... ........._.................................................. ............................ <br /> DisposalField (Specify Requirements( --------•........................•......-...•.•...---............................................................................. <br /> ._.. <br /> ...................... <br /> ... <br /> ............. .--..........---.-----........_.......--•--•••-•.................... <br /> ......................................... <br /> ............ <br /> 1 (Draw existing and required addition on reverse sive) <br /> I herehy certify that i« have prepared this application and that the worst will be done In accordance 'wlih Sart j"gyla <br /> County Ordinances, State Laws, anJ Rules and Regulations of the Son Joaquin Local Health District. Hoang owner or Won- <br /> k sett agents slgnGturra certifies the following: <br /> "I certify ;hot In tho performance of the warir for wench this permit 6s issued ii shall nog employ-any person-I'n-such <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed .... .. .................I............................................. Owner <br /> ---..Jitle ......... .............................. ................••. <br /> t (If other than owner) <br /> ` FOR DEPARTMEtsT USE ONLY <br /> APPLICATION ACCEPTED BY .. !- ,01 ; DAv1r -/Q- <br /> HElEi E lld:'i PERMIT ISS►�!ED ....,.. - ................... -----.DATE . .... ................... <br /> ADDITIONALCOMMENTS .............................................................-!..............I'll........................... ....... .................-......-.._.:. ...... <br /> 4 ................ ....................,............V.... ..................................................... <br /> .... .......... ....�.r...•.....•.........•.•.•............ .... ..........'. <br /> ............... <br /> .................. <br /> ..... <br /> .....-....... <br /> .......- <br /> €€,, <br /> i .......... ....._................... .-.... f......................................... --•- .. ... - ....... <br /> ...... ... . .: <br /> l��t� ..moi.- /1 :7.7 . <br /> Fms�fi inspection by. ---.. .-. ......................................... i�'� <br /> 33 24 1-68 R--v. SAKI JOAGUIN LOVA HEALTH DISTRICT 7 <br /> � rj"i <br />